Healthcare Provider Details

I. General information

NPI: 1922353309
Provider Name (Legal Business Name): MARTINA CHANDLER CR, LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2012
Last Update Date: 08/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1519 NW SMITH AVE
LAWTON OK
73507-2648
US

IV. Provider business mailing address

1519 NW SMITH AVE
LAWTON OK
73507-2648
US

V. Phone/Fax

Practice location:
  • Phone: 580-583-2739
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code173C00000X
TaxonomyReflexologist
License Number
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT113631
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: