Healthcare Provider Details

I. General information

NPI: 1831000363
Provider Name (Legal Business Name): CHAELEY BOYKIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

640 SUPERIOR CT
MEDFORD OR
97504-6181
US

IV. Provider business mailing address

640 SUPERIOR CT
MEDFORD OR
97504-6181
US

V. Phone/Fax

Practice location:
  • Phone: 575-993-9398
  • Fax:
Mailing address:
  • Phone: 575-993-9398
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number66068
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: