Provider Demographics
NPI:1538509179
Name:EARLY, SHELLEY G (OT)
Entity Type:Individual
Prefix:
First Name:SHELLEY
Middle Name:G
Last Name:EARLY
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11140 N HARRELLS FERRY RD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-8307
Mailing Address - Country:US
Mailing Address - Phone:225-272-0150
Mailing Address - Fax:225-275-0930
Practice Address - Street 1:11140 N HARRELLS FERRY RD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816-8307
Practice Address - Country:US
Practice Address - Phone:225-272-0150
Practice Address - Fax:225-275-0930
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-27
Last Update Date:2017-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAOTT.200652225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist