Individual
KATHRYN CHASSEREAU
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
L.M.T.
Contact information
Practice address
29846 ELLENSBURG AVE, GOLD BEACH, OR 97444-0650
(541) 698-8409
(541) 247-9509
Mailing address
PO BOX 650, GOLD BEACH, OR 97444-0650
(541) 698-8409
(541) 247-9509
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
15866
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
15866
MASSAGE LICENSE
OR
Enumeration date
09/13/2013
Last updated
09/13/2013
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