Provider Demographics
NPI:1891001673
Name:CHAPIN, WAYNE GILES (LMP)
Entity Type:Individual
Prefix:MR
First Name:WAYNE
Middle Name:GILES
Last Name:CHAPIN
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1285 BABY DOLL RD SE
Mailing Address - Street 2:
Mailing Address - City:PORT ORCHARD
Mailing Address - State:WA
Mailing Address - Zip Code:98366-3844
Mailing Address - Country:US
Mailing Address - Phone:360-550-6576
Mailing Address - Fax:360-871-8226
Practice Address - Street 1:1616 SE ELLIS CT
Practice Address - Street 2:SUITE 230
Practice Address - City:PORT ORCHARD
Practice Address - State:WA
Practice Address - Zip Code:98367-8598
Practice Address - Country:US
Practice Address - Phone:360-550-6576
Practice Address - Fax:360-871-8226
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-31
Last Update Date:2012-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60180346225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist