Provider Demographics
NPI:1427399823
Name:SHRIVER, KALEIGH
Entity Type:Individual
Prefix:MS
First Name:KALEIGH
Middle Name:
Last Name:SHRIVER
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 1:409 W LINE ST APT A
Mailing Address - Street 2:
Mailing Address - City:MINERVA
Mailing Address - State:OH
Mailing Address - Zip Code:44657-1912
Mailing Address - Country:US
Mailing Address - Phone:330-324-1674
Mailing Address - Fax:
Practice Address - Street 1:409 W LINE ST APT A
Practice Address - Street 2:
Practice Address - City:MINERVA
Practice Address - State:OH
Practice Address - Zip Code:44657-1912
Practice Address - Country:US
Practice Address - Phone:330-324-1674
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-09
Last Update Date:2013-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant