=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548072390
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SHAYLYNN CHASE LMT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/20/2025
-----------------------------------------------------
Last Update Date | 01/20/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3907 CREEKSIDE LOOP STE 100
-----------------------------------------------------
City | YAKIMA
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98902-4879
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 509-895-7535
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5780 LATERAL B RD
-----------------------------------------------------
City | WAPATO
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98951-9729
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 509-281-2079
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number | MA61649840
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------