Provider Demographics
NPI:1639498611
Name:SHAY, CHELSEA ANN (MOT/L)
Entity type:Individual
Prefix:
First Name:CHELSEA
Middle Name:ANN
Last Name:SHAY
Suffix:
Gender:F
Credentials:MOT/L
Other - Prefix:
Other - First Name:CHELSEA
Other - Middle Name:ANN
Other - Last Name:CHAMIZO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MOT/L
Mailing Address - Street 1:10180 SE SUNNYSIDE RD
Mailing Address - Street 2:
Mailing Address - City:CLACKAMAS
Mailing Address - State:OR
Mailing Address - Zip Code:97015-8970
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1331 NW EASTMAN PKWY
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-3896
Practice Address - Country:US
Practice Address - Phone:503-261-4550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-31
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR275443225X00000X
225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist