Provider Demographics
NPI:1518313733
Name:ADAMS, SHELLEI (OT R/L)
Entity Type:Individual
Prefix:MRS
First Name:SHELLEI
Middle Name:
Last Name:ADAMS
Suffix:
Gender:F
Credentials:OT R/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3631 TOMS CREEK RD
Mailing Address - Street 2:
Mailing Address - City:MARTIN
Mailing Address - State:GA
Mailing Address - Zip Code:30557-3103
Mailing Address - Country:US
Mailing Address - Phone:706-988-8398
Mailing Address - Fax:
Practice Address - Street 1:23 BIG A RD
Practice Address - Street 2:
Practice Address - City:TOCCOA
Practice Address - State:GA
Practice Address - Zip Code:30577
Practice Address - Country:US
Practice Address - Phone:770-207-6390
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-06
Last Update Date:2016-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT005144225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
277445OtherNBCOT CERTIFICATION
GAOT005144OtherOT GA LICENSE