Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 21451 | OR |
NPI | 1013540285 |
---|---|
Provider Name | Ms. Katrina Shaw |
First Address | Springfield, OR 97477-1339 |
Second Address | Springfield, OR 97477-1339 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/02/2020 |
Last Update Date | 24/03/2020 |