Provider Demographics
NPI:1023516440
Name:STILLMAN, CHELSEA (LMT)
Entity type:Individual
Prefix:MS
First Name:CHELSEA
Middle Name:
Last Name:STILLMAN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3157 N FRUITLAND LN
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83815-8165
Mailing Address - Country:US
Mailing Address - Phone:208-818-0642
Mailing Address - Fax:
Practice Address - Street 1:3157 N FRUITLAND LN
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83815-8165
Practice Address - Country:US
Practice Address - Phone:208-818-0642
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-31
Last Update Date:2018-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDMASS-1477225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty