Provider Demographics
NPI:1831318740
Name:CHAPIN, WANDA JOYCE (LMP)
Entity Type:Individual
Prefix:MS
First Name:WANDA
Middle Name:JOYCE
Last Name:CHAPIN
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 304
Mailing Address - Street 2:
Mailing Address - City:COSMOPOLIS
Mailing Address - State:WA
Mailing Address - Zip Code:98537-0304
Mailing Address - Country:US
Mailing Address - Phone:360-537-0777
Mailing Address - Fax:360-537-7078
Practice Address - Street 1:110 W MARKET ST
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:WA
Practice Address - Zip Code:98520-6206
Practice Address - Country:US
Practice Address - Phone:360-537-0777
Practice Address - Fax:360-537-7078
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00013323225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMA00013323OtherSTATE OF WA HEALTH LIC.
WA023176OtherCITY BUS. LIC.