Individual
MS. SHELLEY HENLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ITDS
Contact information
Practice address
681 JERRELLS AVE, FORT WALTON BEACH, FL 32547-3187
(850) 797-0550
Mailing address
681 JERRELLS AVE, FORT WALTON BEACH, FL 32547-3187
(850) 797-0550
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PENDING
—
FL
Enumeration date
04/23/2010
Last updated
04/23/2010
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