Provider Demographics
NPI:1235389214
Name:BARTOCH, SHELLY A
Entity Type:Individual
Prefix:MRS
First Name:SHELLY
Middle Name:A
Last Name:BARTOCH
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 1:102 E HACKBERRY ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SALEM
Mailing Address - State:IN
Mailing Address - Zip Code:47167-2002
Mailing Address - Country:US
Mailing Address - Phone:812-586-0156
Mailing Address - Fax:
Practice Address - Street 1:102 E HACKBERRY ST
Practice Address - Street 2:SUITE 100
Practice Address - City:SALEM
Practice Address - State:IN
Practice Address - Zip Code:47167-2002
Practice Address - Country:US
Practice Address - Phone:812-586-0156
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-25
Last Update Date:2008-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist