Provider Demographics
NPI:1538504808
Name:HARLEY, SHANNON SUELLEN (LMT)
Entity Type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:SUELLEN
Last Name:HARLEY
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 1:308 N QUEEN ST
Mailing Address - Street 2:
Mailing Address - City:LITTLESTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17340-1222
Mailing Address - Country:US
Mailing Address - Phone:717-688-1965
Mailing Address - Fax:
Practice Address - Street 1:308 N QUEEN ST
Practice Address - Street 2:
Practice Address - City:LITTLESTOWN
Practice Address - State:PA
Practice Address - Zip Code:17340-1222
Practice Address - Country:US
Practice Address - Phone:717-688-1965
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-01
Last Update Date:2013-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMSG004567225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist