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General NPI Number Information
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NPI Number | 1699335448
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Entity Type | Individual
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Provider Name | STEVEN OTIS SHEKELS
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Gender | Male
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Dates
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Enumeration Date | 06/14/2019
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Last Update Date | 06/14/2019
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Provider Practice Location Address
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Address Line | 134 W HURON ST
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City | BERLIN
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State | WI
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Zip | 54923-1571
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Country | US
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Telephone | 920-290-3464
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Fax |
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Provider Business Mailing Address
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Address Line | W5879 ELK LN
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City | WESTFIELD
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State | WI
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Zip | 53964-8822
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Country | US
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Telephone | 608-548-8583
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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 | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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