Provider Demographics
NPI:1013560192
Name:STIMMEL, SHELBY ALEXANDRA (ATC,LAT)
Entity Type:Individual
Prefix:
First Name:SHELBY
Middle Name:ALEXANDRA
Last Name:STIMMEL
Suffix:
Gender:F
Credentials:ATC,LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:535 MONUMENT VW
Mailing Address - Street 2:
Mailing Address - City:LAKESIDE MARBLEHEAD
Mailing Address - State:OH
Mailing Address - Zip Code:43440-1282
Mailing Address - Country:US
Mailing Address - Phone:678-983-5882
Mailing Address - Fax:
Practice Address - Street 1:2400 OLENTANGY RIVER RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43210-1027
Practice Address - Country:US
Practice Address - Phone:614-688-3280
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-18
Last Update Date:2022-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
OHAT0065992255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program