Provider Demographics
NPI:1053169284
Name:BROOKS, SHANNON ANN (LMT)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:ANN
Last Name:BROOKS
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 1:806 IKE MOONEY RD NE
Mailing Address - Street 2:
Mailing Address - City:SILVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97381-8707
Mailing Address - Country:US
Mailing Address - Phone:503-562-0654
Mailing Address - Fax:
Practice Address - Street 1:401 RATCLIFF DR SE STE 190
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-4942
Practice Address - Country:US
Practice Address - Phone:503-588-6633
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-13
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR26477225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist