Provider Demographics
NPI:1235934456
Name:ATCHLEY, MISHELLE LANA (CMT)
Entity type:Individual
Prefix:
First Name:MISHELLE
Middle Name:LANA
Last Name:ATCHLEY
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4773 E STATE ST # 1
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91762-3903
Mailing Address - Country:US
Mailing Address - Phone:909-996-7374
Mailing Address - Fax:
Practice Address - Street 1:4773 E STATE ST # 1
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91762-3903
Practice Address - Country:US
Practice Address - Phone:909-996-7374
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-13
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14770225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist