Provider Demographics
NPI:1013540285
Name:SHAW, KATRINA (LMT)
Entity Type:Individual
Prefix:MS
First Name:KATRINA
Middle Name:
Last Name:SHAW
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:498 HARLOW RD STE 3
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97477-1339
Mailing Address - Country:US
Mailing Address - Phone:541-341-1414
Mailing Address - Fax:541-653-8570
Practice Address - Street 1:498 HARLOW RD STE 3
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97477-1339
Practice Address - Country:US
Practice Address - Phone:541-341-1414
Practice Address - Fax:541-653-8570
Is Sole Proprietor?:No
Enumeration Date:2020-02-17
Last Update Date:2020-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR21451225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist