Provider Demographics
NPI:1821323452
Name:HESLA, SHELLEY LYNNETTE (COTA/L)
Entity Type:Individual
Prefix:MRS
First Name:SHELLEY
Middle Name:LYNNETTE
Last Name:HESLA
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:MISS
Other - First Name:SHELLEY
Other - Middle Name:LYNNETTE
Other - Last Name:ROFFMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA/L
Mailing Address - Street 1:575 4TH ST SE
Mailing Address - Street 2:
Mailing Address - City:WAUKON
Mailing Address - State:IA
Mailing Address - Zip Code:52172-2057
Mailing Address - Country:US
Mailing Address - Phone:563-568-4764
Mailing Address - Fax:
Practice Address - Street 1:575 4TH ST SE
Practice Address - Street 2:
Practice Address - City:WAUKON
Practice Address - State:IA
Practice Address - Zip Code:52172-2057
Practice Address - Country:US
Practice Address - Phone:563-568-4764
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-15
Last Update Date:2009-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00108224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant