MEDICARE: SHAILA BOULTON 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	16089	OH

General Provider Information

NPI Number	:	1740447846
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAILA BOULTON LMT

Provider Business Mailing Address
First Line	:	12925 PATTERSON RD
Second Line	:
City	:	NORTH LAWRENCE
State	:	OH
Zip	:	44666-9730
Country	:	US
Telephone Number	:	330-696-5229
Fax Number	:

Provider Business Practice Location Address
First Line	:	12925 PATTERSON RD
Second Line	:
City	:	NORTH LAWRENCE
State	:	OH
Zip	:	44666-9730
Country	:	US
Telephone Number	:	330-696-5229
Fax Number	:

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

Provider Enumeration Date	:	05/18/2008
Last Update Date	:	05/18/2008

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Directions to “ SHAILA BOULTON LMT” Practice Location

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