Provider Demographics
NPI:1376053579
Name:HUTCHINS, SHELBY ALYSSA (BS, LAT, ATC)
Entity Type:Individual
Prefix:
First Name:SHELBY
Middle Name:ALYSSA
Last Name:HUTCHINS
Suffix:
Gender:F
Credentials:BS, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5129 W TEMPERANCE RD
Mailing Address - Street 2:
Mailing Address - City:OTTAWA LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:49267-8717
Mailing Address - Country:US
Mailing Address - Phone:347-316-0457
Mailing Address - Fax:
Practice Address - Street 1:701 N CLINTON ST
Practice Address - Street 2:
Practice Address - City:DEFIANCE
Practice Address - State:OH
Practice Address - Zip Code:43512-1610
Practice Address - Country:US
Practice Address - Phone:419-783-2529
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-03
Last Update Date:2018-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIH325765064830OtherDRIVERS LICENSE