Provider Demographics
NPI:1700248127
Name:SAUNDERS, SHANNON MURLENE
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:MURLENE
Last Name:SAUNDERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16993 THIRD ST
Mailing Address - Street 2:
Mailing Address - City:COPEMISH
Mailing Address - State:MI
Mailing Address - Zip Code:49625
Mailing Address - Country:US
Mailing Address - Phone:231-871-0361
Mailing Address - Fax:
Practice Address - Street 1:3337 S AIRPORT RD W STE 2
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-7927
Practice Address - Country:US
Practice Address - Phone:231-922-8100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-24
Last Update Date:2016-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7501001148225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist