MEDICARE: SHEA ATKIN LMT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	MA33054	FL

General Provider Information

NPI Number	:	1053665455
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHEA ATKIN LMT

Provider Business Mailing Address
First Line	:	104 W 5TH AVE
Second Line	:
City	:	TALLAHASSEE
State	:	FL
Zip	:	32303-6125
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	104 W 5TH AVE
Second Line	:
City	:	TALLAHASSEE
State	:	FL
Zip	:	32303-6125
Country	:	US
Telephone Number	:	850-445-8447
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/07/2012
Last Update Date	:	11/07/2012

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