Individual
BRIDGET DIANE SHELLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
56-592 PUALALEA PL, KAHUKU, HI 96731-2047
(808) 292-7968
Mailing address
55-607 MOANA ST, LAIE, HI 96762-1237
(480) 204-6831
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-22-226614
AZ
Other
Enumeration date
08/29/2022
Last updated
08/31/2022
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