Provider Demographics
NPI:1427820109
Name:SHEA-BURGESS, MAUREEN CLARE (CMT)
Entity type:Individual
Prefix:
First Name:MAUREEN
Middle Name:CLARE
Last Name:SHEA-BURGESS
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17920 SQUIRREL HAVEN LN
Mailing Address - Street 2:
Mailing Address - City:MEADOW VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:95722-9446
Mailing Address - Country:US
Mailing Address - Phone:530-210-3638
Mailing Address - Fax:
Practice Address - Street 1:10052 ALTA SIERRA DR STE E
Practice Address - Street 2:
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95949-6886
Practice Address - Country:US
Practice Address - Phone:530-210-3638
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-25
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA90746225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist