Provider Demographics
NPI:1790476679
Name:ROICE, CHANTEL CAMILLE (LMT)
Entity type:Individual
Prefix:
First Name:CHANTEL
Middle Name:CAMILLE
Last Name:ROICE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:TILLIE
Other - Middle Name:CAMILLE
Other - Last Name:ROICE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMT
Mailing Address - Street 1:3125 SW CAROLINA ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-1038
Mailing Address - Country:US
Mailing Address - Phone:307-710-4929
Mailing Address - Fax:
Practice Address - Street 1:4050 NE BROADWAY ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-1828
Practice Address - Country:US
Practice Address - Phone:307-710-4929
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-19
Last Update Date:2025-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR27706225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist