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General NPI Number Information
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NPI Number | 1174908792
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Entity Type | Individual
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Provider Name | SHELLEY SUE WALSH
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Gender | Female
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Dates
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Enumeration Date | 07/24/2015
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Last Update Date | 07/24/2015
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Provider Practice Location Address
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Address Line | 16844 SAINT CLAIR AVE
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City | EAST LIVERPOOL
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State | OH
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Zip | 43920-4277
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Country | US
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Telephone | 330-386-6500
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Fax | 330-386-1277
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Provider Business Mailing Address
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Address Line | 1265 BOARDMAN CANFIELD RD
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City | BOARDMAN
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State | OH
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Zip | 44512-4004
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Country | US
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Telephone | 330-758-9400
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Fax | 330-726-8676
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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 | 021091
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License Number State | OH
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