Provider Demographics
NPI:1982890471
Name:CULVER, SHAE RENEE (LMT)
Entity Type:Individual
Prefix:MRS
First Name:SHAE
Middle Name:RENEE
Last Name:CULVER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:714 N SANDUSKY AVE
Mailing Address - Street 2:
Mailing Address - City:UPPER SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:43351-1030
Mailing Address - Country:US
Mailing Address - Phone:419-294-9490
Mailing Address - Fax:419-294-2946
Practice Address - Street 1:714 N SANDUSKY AVE
Practice Address - Street 2:
Practice Address - City:UPPER SANDUSKY
Practice Address - State:OH
Practice Address - Zip Code:43351-1030
Practice Address - Country:US
Practice Address - Phone:419-294-9490
Practice Address - Fax:419-294-2946
Is Sole Proprietor?:No
Enumeration Date:2007-09-19
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH15641174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist