Provider Demographics
NPI:1568890283
Name:SHAW, DEBRA ANN (LMT)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:ANN
Last Name:SHAW
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 1:263 STATE ST
Mailing Address - Street 2:SUITE 6
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-5435
Mailing Address - Country:US
Mailing Address - Phone:207-989-7473
Mailing Address - Fax:
Practice Address - Street 1:263 STATE ST
Practice Address - Street 2:SUITE 6
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-5435
Practice Address - Country:US
Practice Address - Phone:207-989-7473
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-15
Last Update Date:2013-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMT2872225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist