Provider Demographics
NPI:1376053579
Name:HUTCHINS, SHELBY ALYSSA (MBA, AT, ATC)
Entity type:Individual
Prefix:
First Name:SHELBY
Middle Name:ALYSSA
Last Name:HUTCHINS
Suffix:
Gender:F
Credentials:MBA, AT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1139 DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:ADRIAN
Mailing Address - State:MI
Mailing Address - Zip Code:49221-4214
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6518 SAND CREEK HWY
Practice Address - Street 2:
Practice Address - City:SAND CREEK
Practice Address - State:MI
Practice Address - Zip Code:49279-9703
Practice Address - Country:US
Practice Address - Phone:734-731-6045
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-03
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2601002267OtherSTATE LICENSURE
2000023721OtherBOC