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General NPI Number Information
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NPI Number | 1225721640
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Entity Type | Individual
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Provider Name | CHANTAL CALAIS WAFFLER LMT
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Gender | Female
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Dates
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Enumeration Date | 05/31/2023
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Last Update Date | 03/12/2024
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Provider Practice Location Address
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Address Line | 260 N CHERRY ST
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City | MONTICELLO
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State | FL
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Zip | 32344-1925
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Country | US
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Telephone | 850-320-1122
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Fax |
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Provider Business Mailing Address
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Address Line | 475 FORNES RD
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City | MONTICELLO
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State | FL
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Zip | 32344-5892
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Country | US
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Telephone | 850-320-1122
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MAS.12934R
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MA-100555
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License Number State | FL
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