Provider Demographics
NPI:1902554611
Name:TREHARNE, CHELSEA DAWN (LMT)
Entity Type:Individual
Prefix:
First Name:CHELSEA
Middle Name:DAWN
Last Name:TREHARNE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2122 W 16TH ST
Mailing Address - Street 2:
Mailing Address - City:THE DALLES
Mailing Address - State:OR
Mailing Address - Zip Code:97058-3810
Mailing Address - Country:US
Mailing Address - Phone:503-405-2778
Mailing Address - Fax:
Practice Address - Street 1:102 E 2ND ST
Practice Address - Street 2:
Practice Address - City:THE DALLES
Practice Address - State:OR
Practice Address - Zip Code:97058-1733
Practice Address - Country:US
Practice Address - Phone:415-288-1995
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-11
Last Update Date:2022-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10872225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR10872OtherLICENSED MASSAGE THERAPIST