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General NPI Number Information
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NPI Number | 1932364668
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Entity Type | Organization
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Legal Business Name | SCIOTO SHOE MART INC
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Dates
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Enumeration Date | 07/22/2008
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Last Update Date | 07/29/2009
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Provider Practice Location Address
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Address Line | 206 JAMES WAY
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City | MARION
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State | OH
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Zip | 43302-5818
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Country | US
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Telephone | 740-389-5775
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Fax | 740-389-1269
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Provider Business Mailing Address
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Address Line | 206 JAMES WAY
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City | MARION
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State | OH
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Zip | 43302-5818
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Country | US
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Telephone | 740-389-5775
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Fax | 740-389-1269
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Authorized Official
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Title or Position | MANAGER/ C.PED
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Name | MRS. SHANNON LEE STARK
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Credential | CERTIFIED PEDORTHIST
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Telephone | 740-389-5775
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number |
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License Number State |
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