Provider Demographics
NPI:1497971428
Name:SHELTON, ADRIENNE (OTRL)
Entity Type:Individual
Prefix:MS
First Name:ADRIENNE
Middle Name:
Last Name:SHELTON
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2315 HONEYSUCKLE LN
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72801-5526
Mailing Address - Country:US
Mailing Address - Phone:479-858-6144
Mailing Address - Fax:479-858-6144
Practice Address - Street 1:2315 HONEYSUCKLE LN
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:AR
Practice Address - Zip Code:72801-5526
Practice Address - Country:US
Practice Address - Phone:479-858-6144
Practice Address - Fax:479-858-6144
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROTR813225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5U953OtherAR BLUE CROSS BLUE SHIELD