Provider Demographics
NPI:1306016506
Name:SHOCKLEY BURLAND, JONI L (LMP)
Entity Type:Individual
Prefix:
First Name:JONI
Middle Name:L
Last Name:SHOCKLEY BURLAND
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3330 W COURT ST
Mailing Address - Street 2:SUITE Q
Mailing Address - City:PASCO
Mailing Address - State:WA
Mailing Address - Zip Code:99301-3875
Mailing Address - Country:US
Mailing Address - Phone:509-546-2623
Mailing Address - Fax:
Practice Address - Street 1:3330 W COURT ST
Practice Address - Street 2:SUITE Q
Practice Address - City:PASCO
Practice Address - State:WA
Practice Address - Zip Code:99301-3875
Practice Address - Country:US
Practice Address - Phone:509-546-2623
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-04
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00021147225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist