Provider Demographics
NPI:1114684834
Name:SMALL, CHELSEA (LMT)
Entity Type:Individual
Prefix:
First Name:CHELSEA
Middle Name:
Last Name:SMALL
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 1:8000 SW BRENTWOOD ST APT 26
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-2351
Mailing Address - Country:US
Mailing Address - Phone:503-730-3038
Mailing Address - Fax:
Practice Address - Street 1:14355 SW ALLEN BLVD STE 120
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-4700
Practice Address - Country:US
Practice Address - Phone:503-730-3038
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-18
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR22332225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist