Individual
SHELLY LILLY SLEDGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTA/L
Contact information
Practice address
1910 E MCCORD ST, CENTRALIA, IL 62801-6586
(618) 533-1200
Mailing address
12202 E MIDDLE RD, TEXICO, IL 62889-2804
(618) 237-6070
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
057003285
IL
Other
Enumeration date
03/22/2020
Last updated
03/22/2020
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