Provider Demographics
NPI:1205059177
Name:TAFOYA, SHAWNA ANN (L M T)
Entity type:Individual
Prefix:MS
First Name:SHAWNA
Middle Name:ANN
Last Name:TAFOYA
Suffix:
Gender:F
Credentials:L M T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7951
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98042-0065
Mailing Address - Country:US
Mailing Address - Phone:253-631-5557
Mailing Address - Fax:253-631-5558
Practice Address - Street 1:27111 167TH PL SE
Practice Address - Street 2:SUITE 109
Practice Address - City:COVINGTON
Practice Address - State:WA
Practice Address - Zip Code:98042-7337
Practice Address - Country:US
Practice Address - Phone:253-631-5557
Practice Address - Fax:253-631-5558
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00015292225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMA00015292OtherMASSAGE LICENSE NUMBER