Individual
SHELLEY WHITEHEAD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
5157 US HIGHWAY 61 67, IMPERIAL, MO 63052-1606
(314) 392-8082
Mailing address
5157 US HIGHWAY 61 67, IMPERIAL, MO 63052-1606
(314) 392-8082
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
057.004242
IL
224Z00000X
Occupational Therapy Assistant
Primary
2015001890
MO
Other
Enumeration date
05/26/2016
Last updated
05/26/2016
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