Provider Demographics
NPI:1811468747
Name:BROWN, SHELLEY (OT, CLT)
Entity type:Individual
Prefix:
First Name:SHELLEY
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:OT, CLT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:675 HIGHLAND RD
Mailing Address - Street 2:
Mailing Address - City:WHITMORE LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:48189-9516
Mailing Address - Country:US
Mailing Address - Phone:734-395-5874
Mailing Address - Fax:
Practice Address - Street 1:675 HIGHLAND RD
Practice Address - Street 2:
Practice Address - City:WHITMORE LAKE
Practice Address - State:MI
Practice Address - Zip Code:48189-9516
Practice Address - Country:US
Practice Address - Phone:734-395-5874
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-17
Last Update Date:2018-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201009000225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist