Provider Demographics
NPI:1356740732
Name:O'RIORDAN, SHAELYN RAE (LMT)
Entity type:Individual
Prefix:MS
First Name:SHAELYN
Middle Name:RAE
Last Name:O'RIORDAN
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 1:2575 EASTERN BLVD
Mailing Address - Street 2:STE 109
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-2903
Mailing Address - Country:US
Mailing Address - Phone:717-885-7909
Mailing Address - Fax:
Practice Address - Street 1:2340 EASTERN BLVD
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17402-2897
Practice Address - Country:US
Practice Address - Phone:717-885-7909
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-21
Last Update Date:2015-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMSG008637225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist