Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | E1018939 | HI |
NPI | 1003104241 |
---|---|
Provider Name | Stephanie R Shevy |
First Address | Portland, OR 97225-2438 |
Second Address | Portland, OR 97225-2438 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2011 |
Last Update Date | 20/07/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E1018939 | E1018939 (01) | HI |