=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689551913
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SHANNON HOULE LMT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/19/2025
-----------------------------------------------------
Last Update Date | 08/19/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1208 N 3RD ST
-----------------------------------------------------
City | MARQUETTE
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49855-3010
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 906-228-2765
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 41 OAK VIEW DR
-----------------------------------------------------
City | NEGAUNEE
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49866-9402
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number | 7501015109
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------