Provider Demographics
NPI:1952905812
Name:HARPER, SHELLEY RENEE
Entity Type:Individual
Prefix:
First Name:SHELLEY
Middle Name:RENEE
Last Name:HARPER
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 1:2830 THACKERAY AVE NW
Mailing Address - Street 2:
Mailing Address - City:MASSILLON
Mailing Address - State:OH
Mailing Address - Zip Code:44646-2675
Mailing Address - Country:US
Mailing Address - Phone:330-338-9113
Mailing Address - Fax:
Practice Address - Street 1:2830 THACKERAY AVE NW
Practice Address - Street 2:
Practice Address - City:MASSILLON
Practice Address - State:OH
Practice Address - Zip Code:44646-2675
Practice Address - Country:US
Practice Address - Phone:330-338-9113
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-22
Last Update Date:2020-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0398598Medicaid