Provider Demographics
NPI:1427715374
Name:SHAPLA, URSA LYN
Entity type:Individual
Prefix:
First Name:URSA
Middle Name:LYN
Last Name:SHAPLA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37406 VANCE RD
Mailing Address - Street 2:
Mailing Address - City:POMEROY
Mailing Address - State:OH
Mailing Address - Zip Code:45769-9628
Mailing Address - Country:US
Mailing Address - Phone:503-602-8032
Mailing Address - Fax:
Practice Address - Street 1:8 N COURT ST STE 302
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:OH
Practice Address - Zip Code:45701-2450
Practice Address - Country:US
Practice Address - Phone:503-602-8032
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-25
Last Update Date:2021-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH65.000403171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist