Individual
SHELIA MARSHALL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4021 W BELMONT AVE, CHICAGO, IL 60641-4771
(773) 469-8766
Mailing address
1420 N WALLER AVE, CHICAGO, IL 60651-1158
(773) 469-8766
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
057004149
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
057004149
STATE LICENSE NUMBER
IL
Enumeration date
02/21/2022
Last updated
02/21/2022
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