Provider Demographics
NPI:1235979774
Name:BARLOW, SHELLY
Entity type:Individual
Prefix:
First Name:SHELLY
Middle Name:
Last Name:BARLOW
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11208 S 274TH EAST AVE
Mailing Address - Street 2:
Mailing Address - City:COWETA
Mailing Address - State:OK
Mailing Address - Zip Code:74429-3406
Mailing Address - Country:US
Mailing Address - Phone:918-691-2127
Mailing Address - Fax:
Practice Address - Street 1:11208 S 274TH EAST AVE
Practice Address - Street 2:
Practice Address - City:COWETA
Practice Address - State:OK
Practice Address - Zip Code:74429-3406
Practice Address - Country:US
Practice Address - Phone:918-691-2127
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-31
Last Update Date:2024-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist