Provider Demographics
NPI:1629683792
Name:SHAW, BARBARA L
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:L
Last Name:SHAW
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 1:4383 MUDSOC RD
Mailing Address - Street 2:
Mailing Address - City:PATRIOT
Mailing Address - State:OH
Mailing Address - Zip Code:45658-9131
Mailing Address - Country:US
Mailing Address - Phone:740-379-9447
Mailing Address - Fax:
Practice Address - Street 1:4383 MUDSOC RD
Practice Address - Street 2:
Practice Address - City:PATRIOT
Practice Address - State:OH
Practice Address - Zip Code:45658-9131
Practice Address - Country:US
Practice Address - Phone:740-379-9447
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-15
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2700394251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health