Healthcare Provider Details

I. General information

NPI: 1497892509
Provider Name (Legal Business Name): SHARNELL DAWN WORKMAN CMMP, LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 07/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1902 15TH AVENUE
PARKERSBURG WV
26101-6121
US

IV. Provider business mailing address

1902 15TH AVE
PARKERSBURG WV
26101
US

V. Phone/Fax

Practice location:
  • Phone: 740-236-1407
  • Fax: 740-236-1664
Mailing address:
  • Phone: 740-236-1407
  • Fax: 740-236-1664

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number2002-0965
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: