Provider Demographics
NPI:1215329446
Name:PLINE, SHELBI (MSOT OTR/L)
Entity type:Individual
Prefix:
First Name:SHELBI
Middle Name:
Last Name:PLINE
Suffix:
Gender:F
Credentials:MSOT OTR/L
Other - Prefix:
Other - First Name:SHELBI
Other - Middle Name:
Other - Last Name:WILCOX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9893 PEAKE RD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48875-8420
Mailing Address - Country:US
Mailing Address - Phone:517-526-2395
Mailing Address - Fax:
Practice Address - Street 1:2111 MERRITT RD
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-6916
Practice Address - Country:US
Practice Address - Phone:517-332-3232
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-25
Last Update Date:2016-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201009030225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist