Healthcare Provider Details

I. General information

NPI: 1720916331
Provider Name (Legal Business Name): SHACOLA MARIE THOMPSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2026
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1733 BRAME PL
TOLEDO OH
43613-4625
US

IV. Provider business mailing address

1733 BRAME PL
TOLEDO OH
43613-4625
US

V. Phone/Fax

Practice location:
  • Phone: 419-650-0661
  • Fax:
Mailing address:
  • Phone: 419-650-0661
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: