Healthcare Provider Details

I. General information

NPI: 1972420891
Provider Name (Legal Business Name): ANDREW SHETTERLY LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2026
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9403 KENWOOD RD STE D104
BLUE ASH OH
45242-6859
US

IV. Provider business mailing address

9403 KENWOOD RD STE D104
BLUE ASH OH
45242-6859
US

V. Phone/Fax

Practice location:
  • Phone: 513-813-0780
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number33.012215
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: