Provider Demographics
NPI:1265944185
Name:DAILEY, SHELLEY MARIE (PTA)
Entity type:Individual
Prefix:
First Name:SHELLEY
Middle Name:MARIE
Last Name:DAILEY
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:SHELLEY
Other - Middle Name:MARIE
Other - Last Name:BICKERTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:156 OLIVE PL
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96818-7302
Mailing Address - Country:US
Mailing Address - Phone:808-203-7921
Mailing Address - Fax:
Practice Address - Street 1:156 OLIVE PL
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96818-7302
Practice Address - Country:US
Practice Address - Phone:808-203-7921
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-01
Last Update Date:2017-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant