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Individual

SHELBY LILES

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
COTA

Contact information

Practice address
111 NW MOCK AVE, BLUE SPRINGS, MO 64014-2503
(816) 228-5655
Mailing address
9239 MOUNT ZION RD, ODESSA, MO 64076-6121

Taxonomy

Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
UNSURE
MO
Enumeration date
02/20/2019
Last updated
02/20/2019
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