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General NPI Number Information
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NPI Number | 1295908549
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Entity Type | Individual
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Provider Name | TIA SHEPPARD LMP
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Gender | Female
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Dates
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Enumeration Date | 04/08/2008
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Last Update Date | 09/18/2008
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Provider Practice Location Address
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Address Line | 19820 STATE ROUTE 410 E STE. 20
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City | BONNEY LAKE
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State | WA
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Zip | 98391-6377
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Country | US
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Telephone | 253-863-7510
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Fax | 253-863-5970
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Provider Business Mailing Address
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Address Line | PO BOX 2170
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City | SUMNER
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State | WA
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Zip | 98390-0480
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Country | US
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Telephone | 253-840-2313
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Fax | 253-840-6340
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MA00025044
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License Number State | WA
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