Provider Demographics
NPI:1861643207
Name:O'BRIEN, SHAWN (LMP)
Entity Type:Individual
Prefix:
First Name:SHAWN
Middle Name:
Last Name:O'BRIEN
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:645 TIMES AVE
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98312-3715
Mailing Address - Country:US
Mailing Address - Phone:360-405-6893
Mailing Address - Fax:
Practice Address - Street 1:1008 BETHEL AVE
Practice Address - Street 2:SUITE E
Practice Address - City:PORT ORCHARD
Practice Address - State:WA
Practice Address - Zip Code:98366-4235
Practice Address - Country:US
Practice Address - Phone:360-874-2727
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-03
Last Update Date:2011-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA5287225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist