Individual
SHELLEY SLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
55475 SANTA FE TRL, YUCCA VALLEY, CA 92284-3117
(760) 365-3022
Mailing address
55475 SANTA FE TRL, YUCCA VALLEY, CA 92284-3117
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
3032
CA
Other
Enumeration date
08/12/2009
Last updated
03/24/2015
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