Provider Demographics
NPI:1316002843
Name:MECKLEY, SHAWN (HHA)
Entity Type:Individual
Prefix:
First Name:SHAWN
Middle Name:
Last Name:MECKLEY
Suffix:
Gender:M
Credentials:HHA
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 86
Mailing Address - Street 2:
Mailing Address - City:OLD WASHINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43768-0086
Mailing Address - Country:US
Mailing Address - Phone:740-489-5188
Mailing Address - Fax:
Practice Address - Street 1:200A OLDNATIONAL RD
Practice Address - Street 2:
Practice Address - City:OLDWASHINGTON
Practice Address - State:OH
Practice Address - Zip Code:43768-0086
Practice Address - Country:US
Practice Address - Phone:740-489-5188
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2695472374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide