Healthcare Provider Details

I. General information

NPI: 1578903233
Provider Name (Legal Business Name): CHEVELE ANN HARDIMAN L.M.T / HEALTH COACH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2013
Last Update Date: 06/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

249 LAWN RD
MEADOW BRIDGE WV
25976-9260
US

IV. Provider business mailing address

717 N JEFFERSON ST
LEWISBURG WV
24901-9598
US

V. Phone/Fax

Practice location:
  • Phone: 304-667-3331
  • Fax:
Mailing address:
  • Phone: 304-667-3331
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number2010-2737
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: