Provider Demographics
NPI:1275314122
Name:FRASER, CHLOE DANIELLE
Entity Type:Individual
Prefix:
First Name:CHLOE
Middle Name:DANIELLE
Last Name:FRASER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14717 NW 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98685-5784
Mailing Address - Country:US
Mailing Address - Phone:505-300-7622
Mailing Address - Fax:
Practice Address - Street 1:2100 SE 164TH AVE UNIT C102
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98683-4638
Practice Address - Country:US
Practice Address - Phone:360-254-0994
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-06
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61486296225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist