Provider Demographics
NPI:1336734961
Name:SERRAGLIO, SHELBY NICOLE (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:SHELBY
Middle Name:NICOLE
Last Name:SERRAGLIO
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 1:690 MASON HEADLEY RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40504-2384
Mailing Address - Country:US
Mailing Address - Phone:859-373-0832
Mailing Address - Fax:
Practice Address - Street 1:690 MASON HEADLEY RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40504-2384
Practice Address - Country:US
Practice Address - Phone:859-373-0832
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-05
Last Update Date:2021-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY170674225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist