Provider Demographics
NPI:1992263966
Name:CHILDS, SHEENA A
Entity type:Individual
Prefix:
First Name:SHEENA
Middle Name:A
Last Name:CHILDS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 SE 6TH ST STE 211
Mailing Address - Street 2:
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97526-2471
Mailing Address - Country:US
Mailing Address - Phone:425-931-9654
Mailing Address - Fax:
Practice Address - Street 1:215 SE 6TH ST STE 211
Practice Address - Street 2:
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97526-2471
Practice Address - Country:US
Practice Address - Phone:425-931-9654
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-07
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225700000X
WAMA00019285225700000X
OR225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist