Provider Demographics
NPI:1780943423
Name:SHELLI DRY PEDIATRIC THERAPY, PLLC
Entity type:Organization
Organization Name:SHELLI DRY PEDIATRIC THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHELLI
Authorized Official - Middle Name:
Authorized Official - Last Name:DRY
Authorized Official - Suffix:
Authorized Official - Credentials:OTD, OTR/C
Authorized Official - Phone:502-797-4536
Mailing Address - Street 1:40 LIZAS CIR
Mailing Address - Street 2:
Mailing Address - City:SIMPSONVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40067-5601
Mailing Address - Country:US
Mailing Address - Phone:502-797-4536
Mailing Address - Fax:502-384-8386
Practice Address - Street 1:40 LIZA'S CIR.
Practice Address - Street 2:
Practice Address - City:SIMPSONVILLE
Practice Address - State:KY
Practice Address - Zip Code:40067
Practice Address - Country:US
Practice Address - Phone:502-797-4536
Practice Address - Fax:502-384-8386
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-15
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYR2278174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1235261538OtherINDIVIDUAL NPI