Provider Demographics
NPI:1700031432
Name:SMITH-SANDLIN, SHELLEE D (OT)
Entity Type:Individual
Prefix:
First Name:SHELLEE
Middle Name:D
Last Name:SMITH-SANDLIN
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1325 CHURCHILL HUBBARD RD
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44505-1346
Mailing Address - Country:US
Mailing Address - Phone:330-759-5904
Mailing Address - Fax:330-759-8709
Practice Address - Street 1:10 WILMINGTON AVE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45420-1877
Practice Address - Country:US
Practice Address - Phone:937-258-2196
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-21
Last Update Date:2008-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT 006821225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2577162Medicaid
OH2577162Medicaid