Provider Demographics
NPI:1578719936
Name:MINT, SHELLEY ANN (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:SHELLEY
Middle Name:ANN
Last Name:MINT
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 SHELLENBERGER RD
Mailing Address - Street 2:
Mailing Address - City:BARTON
Mailing Address - State:NY
Mailing Address - Zip Code:13734-2047
Mailing Address - Country:US
Mailing Address - Phone:607-699-3408
Mailing Address - Fax:
Practice Address - Street 1:9 SHELLENBERGER RD
Practice Address - Street 2:
Practice Address - City:BARTON
Practice Address - State:NY
Practice Address - Zip Code:13734-2047
Practice Address - Country:US
Practice Address - Phone:607-699-3408
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-15
Last Update Date:2020-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008155-1225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics