NPI | 1801302849 |
---|---|
Former Name | SHAWNA L. STEWART |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 225700000X Massage Therapist (Licence: OR 18055) |
Additional Taxonomies | 305S00000X Point of Service (Licence: OR 18055) |
Enumeration Date | 2017-12-27 |
Last Update Date | 2020-07-27 |