Provider Demographics
NPI:1104623537
Name:CHISM, LAUREL (LMT)
Entity type:Individual
Prefix:
First Name:LAUREL
Middle Name:
Last Name:CHISM
Suffix:
Gender:
Credentials:LMT
Other - Prefix:
Other - First Name:LAUREL
Other - Middle Name:
Other - Last Name:STEWART
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:134 N PRAIRIE LN
Mailing Address - Street 2:
Mailing Address - City:MARSHFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65706-2323
Mailing Address - Country:US
Mailing Address - Phone:417-450-5137
Mailing Address - Fax:
Practice Address - Street 1:1722 S GLENSTONE AVE STE W
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-1516
Practice Address - Country:US
Practice Address - Phone:417-450-5137
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-25
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2024021365225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist