Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 5172 | OR |
NPI | 1003218892 |
---|---|
Provider Name | Chelle Mitchell |
First Address | Oregon City, OR 97045-1010 |
Second Address | Oregon City, OR 97045-1010 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/09/2014 |
Last Update Date | 23/09/2014 |