Individual
MS. SHAKA D MCCORMICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
2804 OSAGE ST, SAINT LOUIS, MO 63118-4537
(314) 448-0143
Mailing address
PO BOX 27041, SAINT LOUIS, MO 63118-0041
(618) 918-1245
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
2019000899
MO
Other
Enumeration date
01/01/2020
Last updated
01/01/2020
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