Provider Demographics
NPI:1073697298
Name:CONLEY, SHELLEY ANN (ATC, OTC)
Entity Type:Individual
Prefix:
First Name:SHELLEY
Middle Name:ANN
Last Name:CONLEY
Suffix:
Gender:F
Credentials:ATC, OTC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:343 E 1ST ST
Mailing Address - Street 2:
Mailing Address - City:GAYLORD
Mailing Address - State:MI
Mailing Address - Zip Code:49735-1317
Mailing Address - Country:US
Mailing Address - Phone:989-390-1155
Mailing Address - Fax:
Practice Address - Street 1:1371 W MAIN ST
Practice Address - Street 2:SUITE 200
Practice Address - City:GAYLORD
Practice Address - State:MI
Practice Address - Zip Code:49735-7439
Practice Address - Country:US
Practice Address - Phone:989-732-4700
Practice Address - Fax:989-732-4777
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer