Healthcare Provider Details

I. General information

NPI: 1598078149
Provider Name (Legal Business Name): GWENDOLYN SHEARER LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2010
Last Update Date: 07/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10600 SE MCLOUGHLIN BLVD SUITE 206
MILWAUKIE OR
97222-7428
US

IV. Provider business mailing address

PO BOX 6
ESTACADA OR
97023-0006
US

V. Phone/Fax

Practice location:
  • Phone: 503-887-4693
  • Fax:
Mailing address:
  • Phone: 503-887-4693
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number10150
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: