Provider Demographics
NPI:1598917635
Name:EIGENRAAM, SHANA KAY (LMP)
Entity Type:Individual
Prefix:
First Name:SHANA
Middle Name:KAY
Last Name:EIGENRAAM
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 1:1911 181ST ST SE
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98012-6925
Mailing Address - Country:US
Mailing Address - Phone:425-608-0074
Mailing Address - Fax:
Practice Address - Street 1:18001 BOTHELL EVERETT HWY STE K
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98012-6870
Practice Address - Country:US
Practice Address - Phone:425-487-0487
Practice Address - Fax:425-486-4548
Is Sole Proprietor?:No
Enumeration Date:2008-10-21
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60045371225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist