Healthcare Provider Details

I. General information

NPI: 1255583779
Provider Name (Legal Business Name): CHRYSTEL SCHORTAU HOHMANN LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/15/2008
Last Update Date: 08/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 S WHITLEY DR FRUITLAND BUSINESS CENTER SUITE 3
FRUITLAND ID
83619-2611
US

IV. Provider business mailing address

1164 6TH AVE N
PAYETTE ID
83661-2480
US

V. Phone/Fax

Practice location:
  • Phone: 541-235-6061
  • Fax:
Mailing address:
  • Phone: 541-235-6061
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number7726
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: