Provider Demographics
NPI:1336397272
Name:SHELAK, MICHAEL A (OTR/L)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:A
Last Name:SHELAK
Suffix:
Gender:M
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 1:7011 SW STEPHEN LN
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-1507
Mailing Address - Country:US
Mailing Address - Phone:443-569-9234
Mailing Address - Fax:
Practice Address - Street 1:7011 SW STEPHEN LN
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-1507
Practice Address - Country:US
Practice Address - Phone:443-569-9234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-04
Last Update Date:2009-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD05189225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist