MEDICARE: CHELSEA KOSBAB

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	19974	OR

General Provider Information

NPI Number	:	1396168159
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHELSEA KOSBAB

Provider Business Mailing Address
First Line	:	2941 NW HIGHWAY 101
Second Line	:	STE. B
City	:	LINCOLN CITY
State	:	OR
Zip	:	97367-4443
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2941 NW HIGHWAY 101
Second Line	:	STE. B
City	:	LINCOLN CITY
State	:	OR
Zip	:	97367-4443
Country	:	US
Telephone Number	:	541-921-4032
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/30/2014
Last Update Date	:	01/30/2014

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Directions to “ CHELSEA KOSBAB ” Practice Location

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