Provider Demographics
NPI:1962773465
Name:LITTLE, CHELL ANTOINETTE (LMP)
Entity type:Individual
Prefix:
First Name:CHELL
Middle Name:ANTOINETTE
Last Name:LITTLE
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:CHELL
Other - Middle Name:ANTOINETTE
Other - Last Name:CHAMBERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMP
Mailing Address - Street 1:13023 42ND AVE E
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98446-1913
Mailing Address - Country:US
Mailing Address - Phone:253-230-1526
Mailing Address - Fax:
Practice Address - Street 1:1420 3RD ST SE
Practice Address - Street 2:SUITE 102
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98372-3730
Practice Address - Country:US
Practice Address - Phone:253-770-1807
Practice Address - Fax:253-770-1985
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-16
Last Update Date:2018-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00017495225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist