Provider Demographics
NPI:1114258621
Name:CHANEY, AMANDA E (LMT)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:E
Last Name:CHANEY
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 1:3708 E CRESTVIEW DR
Mailing Address - Street 2:
Mailing Address - City:NEWBERG
Mailing Address - State:OR
Mailing Address - Zip Code:97132-9550
Mailing Address - Country:US
Mailing Address - Phone:541-680-8386
Mailing Address - Fax:
Practice Address - Street 1:412 JEFFERSON PKWY STE 204
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-1251
Practice Address - Country:US
Practice Address - Phone:541-680-8386
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-22
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR15564225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR15564OtherSTATE OF OREGON LICENSE