Provider Demographics
NPI:1831784313
Name:CHACHO-BLANCHARD, CARLA A
Entity type:Individual
Prefix:
First Name:CARLA
Middle Name:A
Last Name:CHACHO-BLANCHARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:239 GAY HILL RD
Mailing Address - Street 2:N/A
Mailing Address - City:UNCASVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06382
Mailing Address - Country:US
Mailing Address - Phone:860-367-4849
Mailing Address - Fax:
Practice Address - Street 1:239 GAY HILL RD
Practice Address - Street 2:N/A
Practice Address - City:UNCASVILLE
Practice Address - State:CT
Practice Address - Zip Code:06382
Practice Address - Country:US
Practice Address - Phone:860-367-4849
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-05
Last Update Date:2021-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT10483225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist