Provider Demographics
NPI:1619309366
Name:MOORE, CHELSEA HANA (CMT)
Entity Type:Individual
Prefix:MISS
First Name:CHELSEA
Middle Name:HANA
Last Name:MOORE
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 E WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:DOUGLAS
Mailing Address - State:WY
Mailing Address - Zip Code:82633-2148
Mailing Address - Country:US
Mailing Address - Phone:130-735-8524
Mailing Address - Fax:
Practice Address - Street 1:221 E WALNUT ST
Practice Address - Street 2:
Practice Address - City:DOUGLAS
Practice Address - State:WY
Practice Address - Zip Code:82633-2148
Practice Address - Country:US
Practice Address - Phone:130-735-8524
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-05
Last Update Date:2013-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist