Provider Demographics
NPI:1508953506
Name:STRECKER, SHELLY NICOLE (OTR)
Entity Type:Individual
Prefix:
First Name:SHELLY
Middle Name:NICOLE
Last Name:STRECKER
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 1:4572 HIGHWAY 60 W
Mailing Address - Street 2:
Mailing Address - City:PERRYVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72126-8634
Mailing Address - Country:US
Mailing Address - Phone:501-432-1233
Mailing Address - Fax:
Practice Address - Street 1:4572 HIGHWAY 60 W
Practice Address - Street 2:
Practice Address - City:PERRYVILLE
Practice Address - State:AR
Practice Address - Zip Code:72126-8634
Practice Address - Country:US
Practice Address - Phone:501-432-1233
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROTR1415225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR152801721Medicaid