Provider Demographics
NPI:1427578194
Name:POOL, SHAWNA (LMT)
Entity Type:Individual
Prefix:
First Name:SHAWNA
Middle Name:
Last Name:POOL
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 1:17142 SE NAEGELI DR APT 4
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97236-9372
Mailing Address - Country:US
Mailing Address - Phone:503-462-9762
Mailing Address - Fax:
Practice Address - Street 1:16 NE HOGAN DR # 108
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-7967
Practice Address - Country:US
Practice Address - Phone:503-462-9762
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-23
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR13409225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty