Provider Demographics
NPI:1639800881
Name:SHOCKLEY, TABITHA (LMT)
Entity Type:Individual
Prefix:
First Name:TABITHA
Middle Name:
Last Name:SHOCKLEY
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 1:8788 HERRING BRANCH RD
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:DE
Mailing Address - Zip Code:19960-3933
Mailing Address - Country:US
Mailing Address - Phone:302-402-5522
Mailing Address - Fax:
Practice Address - Street 1:38 CLINTON ST
Practice Address - Street 2:
Practice Address - City:DELAWARE CITY
Practice Address - State:DE
Practice Address - Zip Code:19706-7700
Practice Address - Country:US
Practice Address - Phone:302-402-5522
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-20
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEMT-0015091225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist