Healthcare Provider Details

I. General information

NPI: 1427303569
Provider Name (Legal Business Name): KAREN LEE SHAVIN LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2012
Last Update Date: 07/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1421 CLARKVIEW RD SUITE 206
BALTIMORE MD
21209-2133
US

IV. Provider business mailing address

404 DUNKIRK RD
BALTIMORE MD
21212-1815
US

V. Phone/Fax

Practice location:
  • Phone: 410-296-2644
  • Fax:
Mailing address:
  • Phone: 410-929-6241
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberM24717
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: