Provider Demographics
NPI:1760824759
Name:HOLIMAN, SHELLY YVONNE
Entity Type:Individual
Prefix:MS
First Name:SHELLY
Middle Name:YVONNE
Last Name:HOLIMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 AVENUE B SE
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33880-3037
Mailing Address - Country:US
Mailing Address - Phone:863-294-1429
Mailing Address - Fax:
Practice Address - Street 1:150 AVENUE B SE
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33880-3037
Practice Address - Country:US
Practice Address - Phone:863-294-1429
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-19
Last Update Date:2013-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTT15820225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist