Provider Demographics
NPI:1427303569
Name:SHAVIN, KAREN LEE (LMT)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:LEE
Last Name:SHAVIN
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 1:404 DUNKIRK RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21212-1815
Mailing Address - Country:US
Mailing Address - Phone:410-929-6241
Mailing Address - Fax:
Practice Address - Street 1:1421 CLARKVIEW RD
Practice Address - Street 2:SUITE 206
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21209-2133
Practice Address - Country:US
Practice Address - Phone:410-296-2644
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-16
Last Update Date:2012-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDM24717225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist