Provider Demographics
NPI:1003218892
Name:MITCHELL, CHELLE (LMT)
Entity Type:Individual
Prefix:
First Name:CHELLE
Middle Name:
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 OSPREY DR E
Mailing Address - Street 2:
Mailing Address - City:THOMPSON FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59873-9516
Mailing Address - Country:US
Mailing Address - Phone:503-467-1561
Mailing Address - Fax:
Practice Address - Street 1:15 OSPREY DR E
Practice Address - Street 2:
Practice Address - City:THOMPSON FALLS
Practice Address - State:MT
Practice Address - Zip Code:59873-9516
Practice Address - Country:US
Practice Address - Phone:503-467-1561
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-23
Last Update Date:2023-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5172225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist