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General NPI Number Information
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NPI Number | 1134813009
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Entity Type | Individual
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Provider Name | ANGELIA SHELL LMT
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Gender | Female
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Dates
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Enumeration Date | 06/05/2023
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Last Update Date | 06/05/2023
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Provider Practice Location Address
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Address Line | 113 MO 51
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City | MARBLE HILL
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State | MO
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Zip | 63764
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Country | US
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Telephone | 573-979-4414
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Fax |
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Provider Business Mailing Address
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Address Line | 15290 STATE HIGHWAY 51
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City | ADVANCE
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State | MO
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Zip | 63730-7151
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Country | US
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Telephone | 573-979-4414
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 2016026782
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License Number State | MO
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