Provider Demographics
NPI:1821528233
Name:JEWELL, SHELLEY RENEE (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:SHELLEY
Middle Name:RENEE
Last Name:JEWELL
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4702 MILL PARK CIR
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23060-3670
Mailing Address - Country:US
Mailing Address - Phone:434-610-1888
Mailing Address - Fax:
Practice Address - Street 1:1600 WESTWOOD AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23227-4622
Practice Address - Country:US
Practice Address - Phone:804-474-1800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-18
Last Update Date:2017-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119005901225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist