| NPI | 1417482209 |
|---|---|
| Former Name | CHANTELL CORDELL BENNETT |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: 2000017359) |
| Enumeration Date | 2017-04-28 |
| Last Update Date | 2017-04-28 |