Provider Demographics
NPI:1568863884
Name:SCHUTT, SHANTELL (ATC)
Entity Type:Individual
Prefix:
First Name:SHANTELL
Middle Name:
Last Name:SCHUTT
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:319 5TH ST N
Mailing Address - Street 2:APT 3
Mailing Address - City:WAHPETON
Mailing Address - State:ND
Mailing Address - Zip Code:58075-4434
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:319 5TH ST N
Practice Address - Street 2:APT 3
Practice Address - City:WAHPETON
Practice Address - State:ND
Practice Address - Zip Code:58075-4434
Practice Address - Country:US
Practice Address - Phone:701-301-0442
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-05
Last Update Date:2014-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND511-132255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer