Provider Demographics
NPI:1477676211
Name:HANSEN, SHELLEY MARIE (OTR)
Entity Type:Individual
Prefix:
First Name:SHELLEY
Middle Name:MARIE
Last Name:HANSEN
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 ELM ST
Mailing Address - Street 2:
Mailing Address - City:DE SOTO
Mailing Address - State:IA
Mailing Address - Zip Code:50069-1059
Mailing Address - Country:US
Mailing Address - Phone:515-321-8658
Mailing Address - Fax:
Practice Address - Street 1:301 NE TRILEIN DR
Practice Address - Street 2:SUITE 4
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50021-2170
Practice Address - Country:US
Practice Address - Phone:515-965-7682
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00826225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA16-6591Medicare ID - Type Unspecified