Provider Demographics
NPI:1285130203
Name:SCHMIDT, CHELSEA KAY (LMT)
Entity type:Individual
Prefix:
First Name:CHELSEA
Middle Name:KAY
Last Name:SCHMIDT
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:CHELSEA
Other - Middle Name:ADELINE
Other - Last Name:BAY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMT
Mailing Address - Street 1:1177 SE STARK STREET
Mailing Address - Street 2:APT 116
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214
Mailing Address - Country:US
Mailing Address - Phone:503-899-0732
Mailing Address - Fax:
Practice Address - Street 1:4927 NE 30TH AVE
Practice Address - Street 2:PORTLAND
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97211
Practice Address - Country:US
Practice Address - Phone:503-899-0732
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-30
Last Update Date:2018-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR23842225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty