Provider Demographics
NPI:1790561280
Name:BOIS, CHELSEA MARIE
Entity Type:Individual
Prefix:MRS
First Name:CHELSEA
Middle Name:MARIE
Last Name:BOIS
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:CHELSEA
Other - Middle Name:MARIE
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3212 W HOUSTON PL
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012-3237
Mailing Address - Country:US
Mailing Address - Phone:401-568-9958
Mailing Address - Fax:
Practice Address - Street 1:3212 W HOUSTON PL
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-3237
Practice Address - Country:US
Practice Address - Phone:401-568-9958
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-31
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist