Provider Demographics
NPI:1639683519
Name:SHIVLEY-CASTLE, JACQUELINE LLOYDETTE (COTA/L)
Entity Type:Individual
Prefix:MS
First Name:JACQUELINE
Middle Name:LLOYDETTE
Last Name:SHIVLEY-CASTLE
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 BLUESTONE RD
Mailing Address - Street 2:
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801-2010
Mailing Address - Country:US
Mailing Address - Phone:304-673-1280
Mailing Address - Fax:
Practice Address - Street 1:501 CALDWELL LN
Practice Address - Street 2:
Practice Address - City:DUNBAR
Practice Address - State:WV
Practice Address - Zip Code:25064-2026
Practice Address - Country:US
Practice Address - Phone:304-744-4761
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-29
Last Update Date:2017-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVC1945224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant