Individual
LORI ANN SHAW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
L.M.T.
Contact information
Practice address
5 S CASCO VILLAGE RD, CASCO, ME 04015-4246
(207) 655-2520
Mailing address
32 JEFFERSON CT, NAPLES, ME 04055-5044
(207) 632-3189
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MT2492
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
200719
ANTHEM PROVIDER #
ME
Enumeration date
10/24/2008
Last updated
10/24/2008
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