Basic Information
| Provider Information | |||||||||
| NPI: | 1770714768 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SHAMBLIN | ||||||||
| FirstName: | DARYN | ||||||||
| MiddleName: | MARIE | ||||||||
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| Credential: | COTA/L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 507 FRAME RD APT 8 | ||||||||
| Address2: | |||||||||
| City: | ELKVIEW | ||||||||
| State: | WV | ||||||||
| PostalCode: | 250719294 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3045507387 | ||||||||
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| Practice Location | |||||||||
| Address1: | 590 POPLAR FORK RD | ||||||||
| Address2: | |||||||||
| City: | HURRICANE | ||||||||
| State: | WV | ||||||||
| PostalCode: | 255269434 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3047577826 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/07/2009 | ||||||||
| LastUpdateDate: | 08/07/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 224Z00000X | 1700 | WV | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant |
No ID Information.