Individual
MRS. JEANNIE SHELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR
Contact information
Practice address
1823 BIANCA PL, EASTON, PA 18045-5435
(484) 241-0399
Mailing address
1823 BIANCA PL, EASTON, PA 18045-5435
(610) 868-9727
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
OC003399L
PA
Other
Enumeration date
05/22/2007
Last updated
07/08/2007
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