Provider Demographics
NPI:1215313846
Name:KREEGER, SHELLEY (AT)
Entity type:Individual
Prefix:
First Name:SHELLEY
Middle Name:
Last Name:KREEGER
Suffix:
Gender:F
Credentials:AT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 FOX RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:VAN WERT
Mailing Address - State:OH
Mailing Address - Zip Code:45891-2475
Mailing Address - Country:US
Mailing Address - Phone:419-238-8691
Mailing Address - Fax:419-238-8671
Practice Address - Street 1:140 FOX RD
Practice Address - Street 2:SUITE 101
Practice Address - City:VAN WERT
Practice Address - State:OH
Practice Address - Zip Code:45891-2475
Practice Address - Country:US
Practice Address - Phone:419-238-8691
Practice Address - Fax:419-238-8671
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-05
Last Update Date:2015-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAT0003292255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer