Provider Demographics
NPI:1134854821
Name:THEISS, SHELLIE
Entity type:Individual
Prefix:
First Name:SHELLIE
Middle Name:
Last Name:THEISS
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 1:4130 SECKINGER CT
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43613-3617
Mailing Address - Country:US
Mailing Address - Phone:419-902-1047
Mailing Address - Fax:
Practice Address - Street 1:4130 SECKINGER CT
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43613-3617
Practice Address - Country:US
Practice Address - Phone:419-902-1047
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-18
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist