Provider Demographics
NPI:1134344930
Name:CHAMBERLAIN, REBECCA SUE (LMP)
Entity type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:SUE
Last Name:CHAMBERLAIN
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 76
Mailing Address - Street 2:
Mailing Address - City:LACONNER
Mailing Address - State:WA
Mailing Address - Zip Code:98257-0076
Mailing Address - Country:US
Mailing Address - Phone:360-466-1380
Mailing Address - Fax:360-466-1380
Practice Address - Street 1:413 MORRIS
Practice Address - Street 2:SUITE B
Practice Address - City:LACONNER
Practice Address - State:WA
Practice Address - Zip Code:98257-0076
Practice Address - Country:US
Practice Address - Phone:360-466-1380
Practice Address - Fax:360-466-1380
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00009358225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist