Provider Demographics
NPI:1760040869
Name:FLOWERS, SHELLEY (COTA)
Entity Type:Individual
Prefix:
First Name:SHELLEY
Middle Name:
Last Name:FLOWERS
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2185 STATION VILLAGE WAY APT 2101
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-6522
Mailing Address - Country:US
Mailing Address - Phone:513-833-5898
Mailing Address - Fax:
Practice Address - Street 1:2185 STATION VILLAGE WAY APT 2101
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-6522
Practice Address - Country:US
Practice Address - Phone:513-833-5898
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-03
Last Update Date:2019-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
224Z00000X
CA3780224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Single Specialty