Provider Demographics
NPI:1346215076
Name:STIVERSON, RUTH (ATC)
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:
Last Name:STIVERSON
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:680 N. ELM ST.
Mailing Address - Street 2:
Mailing Address - City:BASCOM
Mailing Address - State:OH
Mailing Address - Zip Code:44809
Mailing Address - Country:US
Mailing Address - Phone:419-937-2149
Mailing Address - Fax:
Practice Address - Street 1:290 N. CR 7
Practice Address - Street 2:
Practice Address - City:BASCOM
Practice Address - State:OH
Practice Address - Zip Code:44809
Practice Address - Country:US
Practice Address - Phone:419-937-2216
Practice Address - Fax:419-937-2516
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0061390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program