Doctor Name: | MARISSA MARIE SHELLY |
NPI Number: | 1346569233 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | SL009752 |
Business Practice Address: | 815 Sycamore Road Mohnton, PA - 19540 |
Business Phone Number: | 5705730065 |
Business Fax Number: | |
Mailing Address: | 815 Sycamore Rd, MOHNTON |
State: | PA |
Postal Code: | 19540 |
Phone Number: | 5705730065 |
Fax Number: | |
NPI Enumeration Date: | 05/18/2010 |
NPI Last Update Date: | 05/06/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | SL009752 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | PA |
Taxonomy Type: | Speech, Language and Hearing Service Providers |
Taxonomy Classification: | Speech-Language Pathologist |
Taxonomy Specialization: | |
Taxonomy Definition: | A speech pathologist is a person qualified by a master |