Provider Demographics
NPI:1467754945
Name:SHALLOW, STEVEN C (CPO)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:C
Last Name:SHALLOW
Suffix:
Gender:M
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 NW WALNUT BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-3800
Mailing Address - Country:US
Mailing Address - Phone:541-757-8543
Mailing Address - Fax:
Practice Address - Street 1:400 NW WALNUT BLVD STE 100
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-3800
Practice Address - Country:US
Practice Address - Phone:541-757-8543
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-03
Last Update Date:2010-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist