Provider Demographics
NPI:1124550751
Name:CHAFFEE, SHANNA (LMT)
Entity Type:Individual
Prefix:
First Name:SHANNA
Middle Name:
Last Name:CHAFFEE
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 1:473 HOQUIAM AVE NE UNIT B
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98059-4667
Mailing Address - Country:US
Mailing Address - Phone:425-531-1125
Mailing Address - Fax:
Practice Address - Street 1:175 1ST PL NW STE C
Practice Address - Street 2:
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027-2746
Practice Address - Country:US
Practice Address - Phone:425-526-7500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-02
Last Update Date:2017-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60381645225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist