MEDICARE: SEAN O'SHEA CAMTC

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	50732	CA

General Provider Information

NPI Number	:	1578189411
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SEAN O'SHEA CAMTC

Provider Business Mailing Address
First Line	:	6601 FLAMING ARROW DR
Second Line	:
City	:	CITRUS HEIGHTS
State	:	CA
Zip	:	95621-4751
Country	:	US
Telephone Number	:	916-532-1626
Fax Number	:

Provider Business Practice Location Address
First Line	:	6601 FLAMING ARROW DR
Second Line	:
City	:	CITRUS HEIGHTS
State	:	CA
Zip	:	95621-4751
Country	:	US
Telephone Number	:	916-532-1626
Fax Number	:

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

Provider Enumeration Date	:	06/16/2020
Last Update Date	:	06/16/2020

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