Provider Demographics
NPI:1518179480
Name:SHOEMAKER, KATHY
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:
Last Name:SHOEMAKER
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 1:10585 BRIAR RD
Mailing Address - Street 2:
Mailing Address - City:CENTERBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43011-8463
Mailing Address - Country:US
Mailing Address - Phone:740-272-3592
Mailing Address - Fax:
Practice Address - Street 1:10585 BRIAR RD
Practice Address - Street 2:
Practice Address - City:CENTERBURG
Practice Address - State:OH
Practice Address - Zip Code:43011-8463
Practice Address - Country:US
Practice Address - Phone:740-272-3592
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2100596OtherPERSONAL CARE AIDE MRDD
OH0124976Medicaid