Individual
MRS. JAMIE DAWN SHACKELFORD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
11791
OR
225700000X
Massage Therapist
Primary
11791
OR
Other
Enumeration date
03/26/2007
Last updated
07/23/2013
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