Healthcare Provider Details

I. General information

NPI: 1861834301
Provider Name (Legal Business Name): SHANNON LOUISE SEXTON POTTER L.M.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SHANNON LOUISE SEXTON L.M.T.

II. Dates (important events)

Enumeration Date: 07/25/2013
Last Update Date: 10/27/2025
Certification Date: 10/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

58 POMFRET ST
PUTNAM CT
06260-1888
US

IV. Provider business mailing address

31 CANTERBURY RD
BROOKLYN CT
06234-1901
US

V. Phone/Fax

Practice location:
  • Phone: 603-315-0525
  • Fax:
Mailing address:
  • Phone: 603-315-0525
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number29011535
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: