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General NPI Number Information
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NPI Number | 1154555266
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Entity Type | Individual
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Provider Name | SHELBY Q FREDERICK LMT, RP
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Gender | Female
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Dates
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Enumeration Date | 05/05/2009
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Last Update Date | 03/19/2024
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Provider Practice Location Address
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Address Line | 10503 BLACKLICK EASTERN RD # 12
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City | PICKERINGTON
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State | OH
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Zip | 43147-7872
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Country | US
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Telephone | 614-288-9251
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Fax | 614-604-8967
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Provider Business Mailing Address
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Address Line | 8021 FENWAY CIR
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City | REYNOLDSBURG
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State | OH
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Zip | 43068-8255
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Country | US
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Telephone | 614-288-9251
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 33.017113
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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