Provider Demographics
NPI:1720895337
Name:CORWIN, SHELBIE NICHOLE (MT)
Entity type:Individual
Prefix:MRS
First Name:SHELBIE
Middle Name:NICHOLE
Last Name:CORWIN
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:468597 E 850 RD
Mailing Address - Street 2:
Mailing Address - City:STILWELL
Mailing Address - State:OK
Mailing Address - Zip Code:74960-3167
Mailing Address - Country:US
Mailing Address - Phone:620-204-0616
Mailing Address - Fax:
Practice Address - Street 1:201 S 2ND ST
Practice Address - Street 2:
Practice Address - City:STILWELL
Practice Address - State:OK
Practice Address - Zip Code:74960-3838
Practice Address - Country:US
Practice Address - Phone:918-696-7220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-17
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1407802986Medicaid