Provider Information for 1487756821
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Ms. OLIVIA LEA SHUTTLEWORTH LICSW
Sex: Female
NPI: 1487756821
Last Updated: 2015-08-27
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1487756821 | ||||||||||||
| Enumeration Date | 2006-09-05 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | YES | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | 1659 HORNBECK RD MORGANTOWN, WV 26508-4757 United States Phone: 304-629-1779 | Fax: | ||||||||||||
| Primary Practice Address | 1659 HORNBECK RD MORGANTOWN, WV 26508-4757 United States Phone: 304-629-1779 | Fax: | ||||||||||||
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