MEDICARE: MARY GOTTSHALL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3747P1801X	Personal Care Attendant

General Provider Information

NPI Number	:	1811713290
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY GOTTSHALL

Provider Business Mailing Address
First Line	:	2525 MEADOWVIEW DR
Second Line	:
City	:	PARKERSBURG
State	:	WV
Zip	:	26104-9704
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	415 36TH ST STE 200
Second Line	:
City	:	PARKERSBURG
State	:	WV
Zip	:	26101-1005
Country	:	US
Telephone Number	:	304-295-0890
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/02/2024
Last Update Date	:	12/02/2024

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Directions to “ MARY GOTTSHALL ” Practice Location

Language	Start Address	Practice Location

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