Provider Demographics
NPI:1265194211
Name:HENRY, CHESNA PHILI (LMT)
Entity type:Individual
Prefix:MISS
First Name:CHESNA
Middle Name:PHILI
Last Name:HENRY
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:MRS
Other - First Name:CHESNA
Other - Middle Name:PHILI
Other - Last Name:WHELCHEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMT
Mailing Address - Street 1:36975 COUNTY ROAD 1610
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:OK
Mailing Address - Zip Code:74572-5097
Mailing Address - Country:US
Mailing Address - Phone:580-399-7008
Mailing Address - Fax:
Practice Address - Street 1:1414 ARLINGTON ST STE 1500
Practice Address - Street 2:
Practice Address - City:ADA
Practice Address - State:OK
Practice Address - Zip Code:74820-2643
Practice Address - Country:US
Practice Address - Phone:580-279-1788
Practice Address - Fax:580-498-0190
Is Sole Proprietor?:No
Enumeration Date:2021-10-07
Last Update Date:2021-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK158538225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist