Provider Demographics
NPI:1245964360
Name:CHAMBERS, KATRINA ROCHELLE (LMT, MMP)
Entity type:Individual
Prefix:
First Name:KATRINA
Middle Name:ROCHELLE
Last Name:CHAMBERS
Suffix:
Gender:F
Credentials:LMT, MMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 MOONLIGHT VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:ASH GROVE
Mailing Address - State:MO
Mailing Address - Zip Code:65604-8160
Mailing Address - Country:US
Mailing Address - Phone:417-839-9726
Mailing Address - Fax:
Practice Address - Street 1:102 MOONLIGHT VALLEY DR
Practice Address - Street 2:
Practice Address - City:ASH GROVE
Practice Address - State:MO
Practice Address - Zip Code:65604-8160
Practice Address - Country:US
Practice Address - Phone:417-839-9726
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-13
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2021031608225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist