Provider Demographics
NPI:1518106350
Name:SHRULL, STEFANIE LAYNE (DI)
Entity Type:Individual
Prefix:
First Name:STEFANIE
Middle Name:LAYNE
Last Name:SHRULL
Suffix:
Gender:F
Credentials:DI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 W 6TH ST
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42276-1414
Mailing Address - Country:US
Mailing Address - Phone:270-893-0045
Mailing Address - Fax:
Practice Address - Street 1:356 AL BEDEL RD
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:KY
Practice Address - Zip Code:42206-9353
Practice Address - Country:US
Practice Address - Phone:270-847-5723
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-18
Last Update Date:2009-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist