Shannon Rae Blair, MA 60263684
Individual provider Active NPI Massage Therapist · Winlock, WA
NPI 1770857971 · NPPES record last updated Aug 8, 2012
Key facts
- NPI
- 1770857971
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Massage Therapist 225700000X
- License
- MA 60263684 (WA)
- Practice address
- 103 SE First Street
Winlock, WA 98596 - Phone
- (360) 520-0955
- NPI assigned
- Mar 6, 2012
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MA 60263684 | WA | MD | Massage Therapist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Massage Therapist | 225700000X | MA 60263684 | WA | Yes |
Addresses
Primary practice location
103 SE First Street
Winlock, WA 98596
Mailing address
Pob 245
103 SE First Street
Winlock, WA 98596
Phone (360) 520-0955
Other providers in Winlock, WA
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- Joshua Bigner
- Dustin Blackwell
- Kimberly Renee Blackwell
- Karissa Amber Boyovich
- Deborah L Byrd
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- Chuen Y Wong
All providers in Winlock, WA · Massage Therapist in Washington
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 8, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.