Provider Demographics
NPI:1659585701
Name:CHANDLER, MARY ESTHER (LMP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ESTHER
Last Name:CHANDLER
Suffix:
Gender:F
Credentials:LMP
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 2314
Mailing Address - Street 2:
Mailing Address - City:MOSES LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:98837-0714
Mailing Address - Country:US
Mailing Address - Phone:509-764-1583
Mailing Address - Fax:509-764-5511
Practice Address - Street 1:1107 S JUNIPER DR
Practice Address - Street 2:
Practice Address - City:MOSES LAKE
Practice Address - State:WA
Practice Address - Zip Code:98837-2313
Practice Address - Country:US
Practice Address - Phone:509-764-1583
Practice Address - Fax:509-764-5511
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00016260225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist