Individual
SANDRA DIANNE SHIVELY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
1901 E HAMILTON ST, KIRKSVILLE, MO 63501-3904
(660) 626-1444
Mailing address
4067 SHELBY 357, SHELBYVILLE, MO 63469-2531
(573) 501-0292
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
2015001725
MO
Other
Enumeration date
01/26/2024
Last updated
02/03/2026
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