Provider Demographics
NPI:1740447846
Name:BOULTON, SHAILA (LMT)
Entity type:Individual
Prefix:
First Name:SHAILA
Middle Name:
Last Name:BOULTON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12925 PATTERSON RD
Mailing Address - Street 2:
Mailing Address - City:NORTH LAWRENCE
Mailing Address - State:OH
Mailing Address - Zip Code:44666-9730
Mailing Address - Country:US
Mailing Address - Phone:330-696-5229
Mailing Address - Fax:
Practice Address - Street 1:12925 PATTERSON RD
Practice Address - Street 2:
Practice Address - City:NORTH LAWRENCE
Practice Address - State:OH
Practice Address - Zip Code:44666-9730
Practice Address - Country:US
Practice Address - Phone:330-696-5229
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-18
Last Update Date:2008-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH16089225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist