Provider Demographics
NPI:1427418938
Name:PAIGE, CHANDEL (LMT)
Entity Type:Individual
Prefix:
First Name:CHANDEL
Middle Name:
Last Name:PAIGE
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 1:408 E 1ST ST
Mailing Address - Street 2:
Mailing Address - City:NEWBERG
Mailing Address - State:OR
Mailing Address - Zip Code:97132-2938
Mailing Address - Country:US
Mailing Address - Phone:503-538-0100
Mailing Address - Fax:971-832-8554
Practice Address - Street 1:408 E 1ST ST
Practice Address - Street 2:
Practice Address - City:NEWBERG
Practice Address - State:OR
Practice Address - Zip Code:97132-2938
Practice Address - Country:US
Practice Address - Phone:503-538-0100
Practice Address - Fax:971-832-8554
Is Sole Proprietor?:No
Enumeration Date:2016-02-25
Last Update Date:2016-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR17926225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist