MEDICARE: SHAWNTAY PRITCHETT LPN, 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	164W00000X	Licensed Practical Nurse	PN 102176-MEDS	OH
2	225700000X	Massage Therapist	33.021538	OH

General Provider Information

NPI Number	:	1497144877
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAWNTAY PRITCHETT LPN, LMT

Provider Business Mailing Address
First Line	:	4879 HAMILTON AVE
Second Line	:	BLDG. D
City	:	CINCINNATI
State	:	OH
Zip	:	45223-1505
Country	:	US
Telephone Number	:	513-614-4443
Fax Number	:

Provider Business Practice Location Address
First Line	:	4879 HAMILTON AVE
Second Line	:	BLDG. D
City	:	CINCINNATI
State	:	OH
Zip	:	45223-1505
Country	:	US
Telephone Number	:	513-614-4443
Fax Number	:

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

Provider Enumeration Date	:	01/22/2015
Last Update Date	:	01/22/2015

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