Individual
SHELBY KAY THIEMS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
600 S SMILEY ST, O FALLON, IL 62269-2316
(618) 632-3507
Mailing address
1164 STONE RD, NEW DOUGLAS, IL 62074-4003
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
22
RESPIRATORY, REHABILITATIVE & RESTORATIVE SERVICE PROVIDERS
—
Enumeration date
08/11/2017
Last updated
08/11/2017
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