Provider Demographics
NPI:1225521818
Name:WILLS, SHAWNDA RAE (LMT)
Entity Type:Individual
Prefix:
First Name:SHAWNDA
Middle Name:RAE
Last Name:WILLS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:SHAWNDA
Other - Middle Name:RAE
Other - Last Name:STURGILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:18055 SW TV HWY
Mailing Address - Street 2:
Mailing Address - City:ALOHA
Mailing Address - State:OR
Mailing Address - Zip Code:97003-3953
Mailing Address - Country:US
Mailing Address - Phone:503-642-3018
Mailing Address - Fax:503-642-3045
Practice Address - Street 1:18055 SW TV HWY
Practice Address - Street 2:
Practice Address - City:ALOHA
Practice Address - State:OR
Practice Address - Zip Code:97003-3953
Practice Address - Country:US
Practice Address - Phone:503-642-3018
Practice Address - Fax:503-642-3045
Is Sole Proprietor?:No
Enumeration Date:2018-06-08
Last Update Date:2018-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDMAS-2564225700000X
OR23958225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist