Provider Demographics
NPI:1750614129
Name:PEVAHOUSE, SHELLEY (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:SHELLEY
Middle Name:
Last Name:PEVAHOUSE
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 1:1198 JOHNNY HALL RD
Mailing Address - Street 2:
Mailing Address - City:BURNS
Mailing Address - State:TN
Mailing Address - Zip Code:37029-5682
Mailing Address - Country:US
Mailing Address - Phone:615-476-7385
Mailing Address - Fax:
Practice Address - Street 1:895 POWERS BLVD
Practice Address - Street 2:
Practice Address - City:WAVERLY
Practice Address - State:TN
Practice Address - Zip Code:37185-1018
Practice Address - Country:US
Practice Address - Phone:931-296-7552
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-16
Last Update Date:2009-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000003064225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist