Provider Demographics
NPI:1720364672
Name:CHELSEA A. GILES LMP
Entity Type:Organization
Organization Name:CHELSEA A. GILES LMP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MASSAGE THERAPIST
Authorized Official - Prefix:MISS
Authorized Official - First Name:CHELSEA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:GILES
Authorized Official - Suffix:
Authorized Official - Credentials:LMP
Authorized Official - Phone:360-909-3771
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 1:415 NE BIRCH ST
Practice Address - Street 2:
Practice Address - City:CAMAS
Practice Address - State:WA
Practice Address - Zip Code:98607-2139
Practice Address - Country:US
Practice Address - Phone:360-909-3771
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-24
Last Update Date:2011-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60055690174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMA60055690OtherMASSAGE THERAPIST