Provider Demographics
NPI:1447423249
Name:CHANDRAMOULEESWARAN, VISALAKSHI (OTR/L)
Entity type:Individual
Prefix:
First Name:VISALAKSHI
Middle Name:
Last Name:CHANDRAMOULEESWARAN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 TIFFANY LN
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03104-4781
Mailing Address - Country:US
Mailing Address - Phone:603-540-8633
Mailing Address - Fax:
Practice Address - Street 1:214 TIFFANY LN
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03104-4781
Practice Address - Country:US
Practice Address - Phone:603-540-8633
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-11
Last Update Date:2013-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1911225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH001864901Medicare PIN