MEDICARE: DR. KATHERINE MARIE SHEA LAC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171100000X	Acupuncturist	AC02046	TX

General Provider Information

NPI Number	:	1942956107
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KATHERINE MARIE SHEA LAC

Provider Business Mailing Address
First Line	:	110 SAN ANTONIO ST STE 130
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78701-4755
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	110 SAN ANTONIO ST STE 130
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78701-4755
Country	:	US
Telephone Number	:	773-817-6174
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/26/2022
Last Update Date	:	07/08/2022

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