Provider Demographics
NPI:1144530783
Name:SHAFER, ANNETTE L (LMT)
Entity type:Individual
Prefix:
First Name:ANNETTE
Middle Name:L
Last Name:SHAFER
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 1:6382 HOFFMAN RD
Mailing Address - Street 2:
Mailing Address - City:WOOSTER
Mailing Address - State:OH
Mailing Address - Zip Code:44691-9644
Mailing Address - Country:US
Mailing Address - Phone:330-466-3326
Mailing Address - Fax:
Practice Address - Street 1:3172 E LINCOLN WAY
Practice Address - Street 2:
Practice Address - City:WOOSTER
Practice Address - State:OH
Practice Address - Zip Code:44691-3757
Practice Address - Country:US
Practice Address - Phone:330-466-3326
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-18
Last Update Date:2017-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH14661225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist