Provider Demographics
NPI:1871064295
Name:SHARP, SHAWNA MARIE (LMT)
Entity type:Individual
Prefix:
First Name:SHAWNA
Middle Name:MARIE
Last Name:SHARP
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2375 COHO AVE NW
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97304-2451
Mailing Address - Country:US
Mailing Address - Phone:541-786-0530
Mailing Address - Fax:
Practice Address - Street 1:910 CAPITOL ST NE STE B
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-1201
Practice Address - Country:US
Practice Address - Phone:541-786-0530
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-10
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR22959225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR22959OtherOREGON BOARD OF MASSAGE THERAPY