Healthcare Provider Details

I. General information

NPI: 1063918357
Provider Name (Legal Business Name): SHELLY L BUDNIK OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2018
Last Update Date: 01/10/2022
Certification Date: 01/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 JOHNSON STREET
ALPENA MI
49707-1434
US

IV. Provider business mailing address

400 JOHNSON STREET
ALPENA MI
49707-1434
US

V. Phone/Fax

Practice location:
  • Phone: 989-356-7707
  • Fax: 989-354-5898
Mailing address:
  • Phone: 989-356-2161
  • Fax: 989-354-5898

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number1036735
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number5201005348
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: