Healthcare Provider Details

I. General information

NPI: 1235261538
Provider Name (Legal Business Name): SHELLI DRY OTD, MED, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/12/2007
Last Update Date: 05/29/2024
Certification Date: 05/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 LIZA'S CIRCLE
SIMPSONVILLE KY
40067
US

IV. Provider business mailing address

40 LIZA'S CIRCLE
SIMPSONVILLE KY
40067
US

V. Phone/Fax

Practice location:
  • Phone: 502-797-4536
  • Fax: 502-890-9486
Mailing address:
  • Phone: 502-797-4536
  • Fax: 502-890-9486

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberKYR2278
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberR2278
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number132372
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: