Provider Demographics
NPI:1417260274
Name:BALLINGER, CHELSEA (MA 00011266)
Entity Type:Individual
Prefix:
First Name:CHELSEA
Middle Name:
Last Name:BALLINGER
Suffix:
Gender:F
Credentials:MA 00011266
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 31847
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98228-3847
Mailing Address - Country:US
Mailing Address - Phone:360-671-6867
Mailing Address - Fax:
Practice Address - Street 1:4097 JAMES ST
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98226-7736
Practice Address - Country:US
Practice Address - Phone:360-671-6867
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-22
Last Update Date:2010-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 00011266225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist