Provider Demographics
NPI:1174003123
Name:BELTZ COX, SHAWN DENISE
Entity Type:Individual
Prefix:
First Name:SHAWN
Middle Name:DENISE
Last Name:BELTZ COX
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 1:2417 EMPIRE RD NE
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44705-4611
Mailing Address - Country:US
Mailing Address - Phone:330-224-9243
Mailing Address - Fax:
Practice Address - Street 1:2417 EMPIRE RD NE
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44705-4611
Practice Address - Country:US
Practice Address - Phone:330-224-9243
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-20
Last Update Date:2018-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH7608548251E00000X, 385HR2060X, 385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care
No251E00000XAgenciesHome Health
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child