Provider Demographics
NPI:1316540016
Name:SHELTON, SUMMER JOY (OTR/L)
Entity type:Individual
Prefix:
First Name:SUMMER
Middle Name:JOY
Last Name:SHELTON
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11046 ALPHARETTA HWY APT 3237
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-5854
Mailing Address - Country:US
Mailing Address - Phone:678-576-8552
Mailing Address - Fax:
Practice Address - Street 1:11046 ALPHARETTA HWY APT 3237
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-5854
Practice Address - Country:US
Practice Address - Phone:678-576-8552
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-17
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT007874225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist