Provider Demographics
NPI:1528692175
Name:DOTTS, SHIRLEY JEAN (LICENSED MEDICAL BIL)
Entity type:Individual
Prefix:MRS
First Name:SHIRLEY
Middle Name:JEAN
Last Name:DOTTS
Suffix:
Gender:F
Credentials:LICENSED MEDICAL BIL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 BARCLAY ST
Mailing Address - Street 2:
Mailing Address - City:CLEARFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:16830-1310
Mailing Address - Country:US
Mailing Address - Phone:814-592-1966
Mailing Address - Fax:814-762-8141
Practice Address - Street 1:620 BARCLAY ST
Practice Address - Street 2:
Practice Address - City:CLEARFIELD
Practice Address - State:PA
Practice Address - Zip Code:16830-1310
Practice Address - Country:US
Practice Address - Phone:814-592-1966
Practice Address - Fax:814-762-8141
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-22
Last Update Date:2020-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMSG002778163WM1400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WM1400XNursing Service ProvidersRegistered NurseNurse Massage Therapist (NMT)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1487922142Medicaid
PA12320555OtherNOT FOR MEDICARE
PA1538458674Medicaid