Provider Demographics
NPI:1104653138
Name:RICHARDS, SHEALYNN MARIE
Entity type:Individual
Prefix:MISS
First Name:SHEALYNN
Middle Name:MARIE
Last Name:RICHARDS
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 1:9273 E 1446 NORTH RD
Mailing Address - Street 2:
Mailing Address - City:FAIRMOUNT
Mailing Address - State:IL
Mailing Address - Zip Code:61841-6350
Mailing Address - Country:US
Mailing Address - Phone:217-799-1190
Mailing Address - Fax:
Practice Address - Street 1:3210 W FORK RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45211-1948
Practice Address - Country:US
Practice Address - Phone:513-605-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-14
Last Update Date:2024-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist