Provider Demographics
NPI:1548078785
Name:PARSONS, SHAELYN RICHELLE
Entity type:Individual
Prefix:
First Name:SHAELYN
Middle Name:RICHELLE
Last Name:PARSONS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 MERRITT ST
Mailing Address - Street 2:
Mailing Address - City:PRIEST RIVER
Mailing Address - State:ID
Mailing Address - Zip Code:83856-6563
Mailing Address - Country:US
Mailing Address - Phone:541-240-0183
Mailing Address - Fax:
Practice Address - Street 1:54 MERRITT ST
Practice Address - Street 2:
Practice Address - City:PRIEST RIVER
Practice Address - State:ID
Practice Address - Zip Code:83856-6563
Practice Address - Country:US
Practice Address - Phone:541-240-0183
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-19
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA61642753225700000X
ID6171146225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist