Provider Demographics
NPI:1720388044
Name:SHELTON, CHENEATA I (MS/OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:CHENEATA
Middle Name:I
Last Name:SHELTON
Suffix:
Gender:F
Credentials:MS/OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14225 MEDINAH PL
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:23831-6589
Mailing Address - Country:US
Mailing Address - Phone:804-796-3273
Mailing Address - Fax:
Practice Address - Street 1:14225 MEDINAH PL
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:VA
Practice Address - Zip Code:23831-6589
Practice Address - Country:US
Practice Address - Phone:804-796-3273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-02
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119003522225XR0403X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XR0403XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistDriving and Community Mobility