Provider Demographics
NPI:1073221024
Name:O'TOOLE, SHEILA (LAC)
Entity Type:Individual
Prefix:
First Name:SHEILA
Middle Name:
Last Name:O'TOOLE
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 604
Mailing Address - Street 2:
Mailing Address - City:WHITETHORN
Mailing Address - State:CA
Mailing Address - Zip Code:95589-0604
Mailing Address - Country:US
Mailing Address - Phone:440-263-7397
Mailing Address - Fax:
Practice Address - Street 1:764 CEDAR ST
Practice Address - Street 2:
Practice Address - City:GARBERVILLE
Practice Address - State:CA
Practice Address - Zip Code:95542-3222
Practice Address - Country:US
Practice Address - Phone:707-923-3644
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-08
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19586171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist