Provider Demographics
NPI:1407357957
Name:VAN METER, SHELBI ALYSS
Entity Type:Individual
Prefix:
First Name:SHELBI
Middle Name:ALYSS
Last Name:VAN METER
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 1:14745 TOWNSHIP ROAD 202 NE
Mailing Address - Street 2:
Mailing Address - City:CROOKSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43731-9537
Mailing Address - Country:US
Mailing Address - Phone:740-624-6416
Mailing Address - Fax:
Practice Address - Street 1:14745 TOWNSHIP ROAD 202 NE
Practice Address - Street 2:
Practice Address - City:CROOKSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43731-9537
Practice Address - Country:US
Practice Address - Phone:740-624-6416
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-21
Last Update Date:2018-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer