Provider Demographics
NPI:1922231646
Name:ROBINSON, SUSAN SHEPARD (LMP)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:SHEPARD
Last Name:ROBINSON
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 1:306 DUCK LAKE DR SE
Mailing Address - Street 2:
Mailing Address - City:OCEAN SHORES
Mailing Address - State:WA
Mailing Address - Zip Code:98569-9666
Mailing Address - Country:US
Mailing Address - Phone:360-500-1945
Mailing Address - Fax:
Practice Address - Street 1:114 E CHANCE A LA MER NE
Practice Address - Street 2:
Practice Address - City:OCEAN SHORES
Practice Address - State:WA
Practice Address - Zip Code:98569-9202
Practice Address - Country:US
Practice Address - Phone:360-500-1945
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-27
Last Update Date:2009-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 00023629225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist