Provider Demographics
NPI:1609210277
Name:SLETTEN, TERRELL GENE
Entity Type:Individual
Prefix:
First Name:TERRELL
Middle Name:GENE
Last Name:SLETTEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:660 PECK AVE
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33919-3124
Mailing Address - Country:US
Mailing Address - Phone:239-482-2145
Mailing Address - Fax:866-728-6060
Practice Address - Street 1:660 PECK AVE
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33919-3124
Practice Address - Country:US
Practice Address - Phone:239-482-2145
Practice Address - Fax:866-728-6060
Is Sole Proprietor?:No
Enumeration Date:2013-04-25
Last Update Date:2019-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCGC058279171WH0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications