Provider Demographics
NPI:1114191509
Name:TRIPP, SHAILEY (LMT, CMT, REIKI II)
Entity Type:Individual
Prefix:PROF
First Name:SHAILEY
Middle Name:
Last Name:TRIPP
Suffix:
Gender:F
Credentials:LMT, CMT, REIKI II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 N VALLEY WAY
Mailing Address - Street 2:APT E 1
Mailing Address - City:PALMER
Mailing Address - State:AK
Mailing Address - Zip Code:99645
Mailing Address - Country:US
Mailing Address - Phone:907-775-3235
Mailing Address - Fax:
Practice Address - Street 1:5800 E COLUMBUS WAY
Practice Address - Street 2:STE 2 & 3
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-7895
Practice Address - Country:US
Practice Address - Phone:907-373-3329
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-16
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK314200225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist