Provider Demographics
NPI:1609336502
Name:RAY, SHAWNA MARIE (LMT)
Entity Type:Individual
Prefix:MS
First Name:SHAWNA
Middle Name:MARIE
Last Name:RAY
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:PO BOX 329
Mailing Address - Street 2:
Mailing Address - City:WILLAMINA
Mailing Address - State:OR
Mailing Address - Zip Code:97396-0329
Mailing Address - Country:US
Mailing Address - Phone:971-241-7928
Mailing Address - Fax:971-275-1314
Practice Address - Street 1:242 NE MAIN ST
Practice Address - Street 2:
Practice Address - City:WILLAMINA
Practice Address - State:OR
Practice Address - Zip Code:97396-2784
Practice Address - Country:US
Practice Address - Phone:971-241-7928
Practice Address - Fax:971-275-1314
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-25
Last Update Date:2019-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR23235225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist