Provider Demographics
NPI:1003600123
Name:FISCH, CHEYANNE RAYNE (LMT)
Entity type:Individual
Prefix:
First Name:CHEYANNE
Middle Name:RAYNE
Last Name:FISCH
Suffix:
Gender:
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 RAMSEY RD
Mailing Address - Street 2:
Mailing Address - City:CHEHALIS
Mailing Address - State:WA
Mailing Address - Zip Code:98532-8908
Mailing Address - Country:US
Mailing Address - Phone:360-972-8859
Mailing Address - Fax:
Practice Address - Street 1:3403 STEAMBOAT ISLAND RD NW
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-4876
Practice Address - Country:US
Practice Address - Phone:360-866-1461
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-04
Last Update Date:2025-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA61660876225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist