Provider Demographics
NPI:1881934867
Name:SHELLEY, KATELYN (OTRL)
Entity type:Individual
Prefix:
First Name:KATELYN
Middle Name:
Last Name:SHELLEY
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:KATELYN
Other - Middle Name:
Other - Last Name:OBERLEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1055 CORNELL RD
Mailing Address - Street 2:FLETCHER BUILDING
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-1657
Mailing Address - Country:US
Mailing Address - Phone:734-487-2890
Mailing Address - Fax:734-485-2892
Practice Address - Street 1:1055 CORNELL RD
Practice Address - Street 2:FLETCHER BUILDING
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-1657
Practice Address - Country:US
Practice Address - Phone:734-487-2890
Practice Address - Fax:734-485-2892
Is Sole Proprietor?:No
Enumeration Date:2013-02-27
Last Update Date:2013-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201007984225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics