Provider Demographics
NPI:1710121983
Name:STEPHENSON, SHILEIGHA DAILEASE (LMT, LMP)
Entity Type:Individual
Prefix:
First Name:SHILEIGHA
Middle Name:DAILEASE
Last Name:STEPHENSON
Suffix:
Gender:F
Credentials:LMT, LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 SE GREENWAY DR
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97080
Mailing Address - Country:US
Mailing Address - Phone:503-545-7159
Mailing Address - Fax:
Practice Address - Street 1:386 N BROADWAY ST
Practice Address - Street 2:
Practice Address - City:ESTACADA
Practice Address - State:OR
Practice Address - Zip Code:97023-8545
Practice Address - Country:US
Practice Address - Phone:503-545-7159
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-01
Last Update Date:2016-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR14538225700000X
WAMA00024877225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist