MEDICARE: KAREN LEE SHAVIN 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	M24717	MD

General Provider Information

NPI Number	:	1427303569
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAREN LEE SHAVIN LMT

Provider Business Mailing Address
First Line	:	404 DUNKIRK RD
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21212-1815
Country	:	US
Telephone Number	:	410-929-6241
Fax Number	:

Provider Business Practice Location Address
First Line	:	1421 CLARKVIEW RD
Second Line	:	SUITE 206
City	:	BALTIMORE
State	:	MD
Zip	:	21209-2133
Country	:	US
Telephone Number	:	410-296-2644
Fax Number	:

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

Provider Enumeration Date	:	07/16/2012
Last Update Date	:	07/16/2012

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