Provider Demographics
NPI:1386358505
Name:DENISON, SHALI NICOLE (OTR/L)
Entity type:Individual
Prefix:
First Name:SHALI
Middle Name:NICOLE
Last Name:DENISON
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 1:13 PENDLETON PL
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37664-2169
Mailing Address - Country:US
Mailing Address - Phone:423-736-7369
Mailing Address - Fax:
Practice Address - Street 1:1241 VOLUNTEER PKWY STE 400
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:TN
Practice Address - Zip Code:37620-4635
Practice Address - Country:US
Practice Address - Phone:910-818-0977
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-11
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7291225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics