Organization
JACKPOT
Active
Organization
JACKPOT
Active
Other names
Casco Wellness Center
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LORI ANN SHAW L.M.T. (COORDINATOR)
(207) 655-2520
Entity
Organization
Contact information
Practice address
5 S CASCO VILLAGE RD, CASCO, ME 04015-4246
(207) 655-2520
Mailing address
5 S CASCO VILLAGE RD, CASCO, ME 04015-4246
(207) 655-2520
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MT2492
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
200719
ANTHEM
ME
Enumeration date
05/02/2008
Last updated
05/02/2008
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