Provider Demographics
NPI:1528163664
Name:MAYER, SHELLY RENEE (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:SHELLY
Middle Name:RENEE
Last Name:MAYER
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 1:12059 VENETIAN WAY
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60467-1023
Mailing Address - Country:US
Mailing Address - Phone:708-301-7980
Mailing Address - Fax:708-301-7980
Practice Address - Street 1:12059 VENETIAN WAY
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60467-1023
Practice Address - Country:US
Practice Address - Phone:708-301-7980
Practice Address - Fax:708-301-7980
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL9927980OtherBC/BS PIN