Provider Demographics
NPI:1699035337
Name:GARRETT, SHANNON M (LMP)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:M
Last Name:GARRETT
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5005 MAIN ST
Mailing Address - Street 2:SUITE 125
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98407-3168
Mailing Address - Country:US
Mailing Address - Phone:253-508-7588
Mailing Address - Fax:
Practice Address - Street 1:5005 MAIN STREET
Practice Address - Street 2:SUITE 125
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98407-3168
Practice Address - Country:US
Practice Address - Phone:253-508-7588
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-28
Last Update Date:2017-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60275882225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0302385OtherSTATE L&I
WA0302421OtherSTATE L&I