Provider Demographics
NPI:1326420225
Name:ADAMS, CHANDRA (MMT/HLP/ME)
Entity Type:Individual
Prefix:
First Name:CHANDRA
Middle Name:
Last Name:ADAMS
Suffix:
Gender:F
Credentials:MMT/HLP/ME
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6330 W NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53213-2051
Mailing Address - Country:US
Mailing Address - Phone:414-258-2476
Mailing Address - Fax:
Practice Address - Street 1:6330 W NORTH AVE
Practice Address - Street 2:
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53213-2051
Practice Address - Country:US
Practice Address - Phone:415-258-2476
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-26
Last Update Date:2015-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI52167-82224P00000X
WI3583-146225700000X
WA102923225C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor