Provider Demographics
NPI:1275831398
Name:FIELDER, CHARLONDA RENEE (MASSAGE THERAPIST)
Entity Type:Individual
Prefix:
First Name:CHARLONDA
Middle Name:RENEE
Last Name:FIELDER
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6700 NE 162ND AVE
Mailing Address - Street 2:SUITE. 415
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98682-3858
Mailing Address - Country:US
Mailing Address - Phone:360-882-0767
Mailing Address - Fax:360-885-2580
Practice Address - Street 1:6700 NE 162ND AVE
Practice Address - Street 2:SUITE. 415
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98682-3858
Practice Address - Country:US
Practice Address - Phone:360-882-0767
Practice Address - Fax:360-885-2580
Is Sole Proprietor?:No
Enumeration Date:2011-03-14
Last Update Date:2011-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA600091076225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist