Provider Demographics
NPI:1104196377
Name:PRESTON, CHELSEY FAITH (LMP)
Entity Type:Individual
Prefix:MS
First Name:CHELSEY
Middle Name:FAITH
Last Name:PRESTON
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:127 LOGAN AVE S # A
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98057-2020
Mailing Address - Country:US
Mailing Address - Phone:206-275-4870
Mailing Address - Fax:206-275-4876
Practice Address - Street 1:7605 SE 27TH ST
Practice Address - Street 2:SUITE 103
Practice Address - City:MERCER ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98040-2835
Practice Address - Country:US
Practice Address - Phone:206-275-4870
Practice Address - Fax:206-275-4876
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-05
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60255418225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist