Individual
CHARLEA SHAY REVENNAUGH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CMS
Contact information
Practice address
110 HIGHLAND AVE, CIRCLEVILLE, OH 43113-1208
(740) 477-1745
Mailing address
110 HIGHLAND AVE, CIRCLEVILLE, OH 43113-1208
(740) 477-1745
Taxonomy
Speciality
Code
Description
License number
State
225400000X
Rehabilitation Practitioner
Primary
—
OH
Other
Enumeration date
12/06/2018
Last updated
12/06/2018
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