MEDICARE: PAULA SHRIVE M. ED.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TS0200X	School Psychologist	CI1005570	OH

General Provider Information

NPI Number	:	1518348754
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAULA SHRIVE M. ED.

Provider Business Mailing Address
First Line	:	6901 MOORFIELD DR
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45230-2224
Country	:	US
Telephone Number	:	513-543-2858
Fax Number	:

Provider Business Practice Location Address
First Line	:	6901 MOORFIELD DR
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45230-2224
Country	:	US
Telephone Number	:	513-543-2858
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/12/2015
Last Update Date	:	06/12/2015

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