Provider Demographics
NPI:1922079946
Name:DAVIS DJURIC, SHELLEY R (OTR/L)
Entity Type:Individual
Prefix:
First Name:SHELLEY
Middle Name:R
Last Name:DAVIS DJURIC
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:USAHC
Mailing Address - Street 2:CMR 457 BOX 294
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09033
Mailing Address - Country:US
Mailing Address - Phone:49162-488-0844
Mailing Address - Fax:
Practice Address - Street 1:USAHC
Practice Address - Street 2:CMR 457 BOX 294
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09033
Practice Address - Country:US
Practice Address - Phone:49162-488-0844
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31003073A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist