Provider Demographics
NPI:1679715445
Name:GILES, CHELSEA ANN (LMP)
Entity Type:Individual
Prefix:MISS
First Name:CHELSEA
Middle Name:ANN
Last Name:GILES
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 1:415 NE BIRCH ST
Mailing Address - Street 2:
Mailing Address - City:CAMAS
Mailing Address - State:WA
Mailing Address - Zip Code:98607-2139
Mailing Address - Country:US
Mailing Address - Phone:360-909-3771
Mailing Address - Fax:
Practice Address - Street 1:1920 W RESERVE ST
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98663-3363
Practice Address - Country:US
Practice Address - Phone:360-909-3771
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-25
Last Update Date:2011-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60055690225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist