Provider Demographics
NPI:1588858369
Name:BILLARD, SHAWN MARIE (PTA)
Entity Type:Individual
Prefix:
First Name:SHAWN
Middle Name:MARIE
Last Name:BILLARD
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 6 BOX 6046
Mailing Address - Street 2:
Mailing Address - City:HAWLEY
Mailing Address - State:PA
Mailing Address - Zip Code:18428-9100
Mailing Address - Country:US
Mailing Address - Phone:570-226-5680
Mailing Address - Fax:570-226-5682
Practice Address - Street 1:HC 6 BOX 6046
Practice Address - Street 2:
Practice Address - City:HAWLEY
Practice Address - State:PA
Practice Address - Zip Code:18428-9100
Practice Address - Country:US
Practice Address - Phone:570-226-5680
Practice Address - Fax:570-226-5682
Is Sole Proprietor?:No
Enumeration Date:2007-09-05
Last Update Date:2007-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATE000916L174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist