Provider Demographics
NPI:1942656939
Name:MAURA SHANNON THERAPEUTIC MASSAGE
Entity Type:Organization
Organization Name:MAURA SHANNON THERAPEUTIC MASSAGE
Other - Org Name:MAURA SHANNON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL MASSAGE PRACTITIONER
Authorized Official - Prefix:MS
Authorized Official - First Name:MAURA
Authorized Official - Middle Name:L
Authorized Official - Last Name:SHANNON
Authorized Official - Suffix:
Authorized Official - Credentials:CLMT
Authorized Official - Phone:508-653-9008
Mailing Address - Street 1:51 BACON ST
Mailing Address - Street 2:
Mailing Address - City:NATICK
Mailing Address - State:MA
Mailing Address - Zip Code:01760-2901
Mailing Address - Country:US
Mailing Address - Phone:508-653-9008
Mailing Address - Fax:
Practice Address - Street 1:51 BACON ST
Practice Address - Street 2:
Practice Address - City:NATICK
Practice Address - State:MA
Practice Address - Zip Code:01760-2901
Practice Address - Country:US
Practice Address - Phone:508-653-9008
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-09
Last Update Date:2016-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2506225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty