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General NPI Number Information
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NPI Number | 1902252679
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Entity Type | Organization
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Legal Business Name | SHAUNA NOELCKE, LLC
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Dates
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Enumeration Date | 05/11/2016
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Last Update Date | 05/11/2016
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Provider Practice Location Address
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Address Line | 45 SYCAMORE AVE APT 1112
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City | CHARLESTON
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State | SC
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Zip | 29407-6732
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Country | US
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Telephone | 937-430-2436
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Fax |
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Provider Business Mailing Address
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Address Line | 45 SYCAMORE AVE APT 1112
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City | CHARLESTON
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State | SC
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Zip | 29407-6732
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Country | US
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Telephone | 937-430-2436
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Fax |
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Authorized Official
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Title or Position | PHYSICAL THERAPIST
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Name | SHAUNA NOELCKE
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Credential | DPT
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Telephone | 937-430-2436
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 7144
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License Number State | SC
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