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General NPI Number Information
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NPI Number | 1659138204
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Entity Type | Individual
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Provider Name | PAIGE ROCHELLE SHANE PTA
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Gender | Female
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Dates
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Enumeration Date | 02/29/2024
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Last Update Date | 02/29/2024
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Provider Practice Location Address
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Address Line | 1762 S BUCHANAN ST
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City | FREMONT
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State | OH
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Zip | 43420-4943
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Country | US
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Telephone | 419-701-1355
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Fax |
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Provider Business Mailing Address
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Address Line | 1762 S BUCHANAN ST
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City | FREMONT
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State | OH
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Zip | 43420-4943
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Country | US
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Telephone | 419-701-1355
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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 | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | PTA013087
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License Number State | OH
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