Provider Demographics
NPI:1750613097
Name:NAVARRE, SHELLEY A
Entity type:Individual
Prefix:
First Name:SHELLEY
Middle Name:A
Last Name:NAVARRE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9460 FEDERAL BLVD
Mailing Address - Street 2:
Mailing Address - City:FEDERAL HEIGHTS
Mailing Address - State:CO
Mailing Address - Zip Code:80260-5826
Mailing Address - Country:US
Mailing Address - Phone:303-667-6032
Mailing Address - Fax:720-306-4615
Practice Address - Street 1:9460 FEDERAL BLVD
Practice Address - Street 2:
Practice Address - City:FEDERAL HEIGHTS
Practice Address - State:CO
Practice Address - Zip Code:80260-5826
Practice Address - Country:US
Practice Address - Phone:303-667-6032
Practice Address - Fax:720-306-4615
Is Sole Proprietor?:No
Enumeration Date:2010-02-11
Last Update Date:2010-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1912225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist