Healthcare Provider Details

I. General information

NPI: 1225626419
Provider Name (Legal Business Name): CHELSEY K BAILEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2021
Last Update Date: 01/06/2021
Certification Date: 01/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 W B ST STE J
SPRINGFIELD OR
97477-4594
US

IV. Provider business mailing address

24472 BOLTON HILL RD
VENETA OR
97487-7703
US

V. Phone/Fax

Practice location:
  • Phone: 541-520-8263
  • Fax:
Mailing address:
  • Phone: 541-520-8263
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number22140
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: