Provider Demographics
NPI:1124343769
Name:WILKINSON, SHELLEY ANN (MOT/L)
Entity type:Individual
Prefix:MRS
First Name:SHELLEY
Middle Name:ANN
Last Name:WILKINSON
Suffix:
Gender:F
Credentials:MOT/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1861 VALLEJO ST
Mailing Address - Street 2:
Mailing Address - City:SEASIDE
Mailing Address - State:CA
Mailing Address - Zip Code:93955-3947
Mailing Address - Country:US
Mailing Address - Phone:831-899-1031
Mailing Address - Fax:
Practice Address - Street 1:200 GLENWOOD CIR
Practice Address - Street 2:C/O SUNDANCE REHABILITATION
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-6741
Practice Address - Country:US
Practice Address - Phone:831-641-9027
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-06
Last Update Date:2010-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1404225X00000X, 225XF0002X, 225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XF0002XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistFeeding, Eating & Swallowing
No225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation