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General NPI Number Information
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NPI Number | 1407670698
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Entity Type | Individual
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Provider Name | SHEA EULISS MSOT, OTR/L
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Gender | Female
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Dates
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Enumeration Date | 11/13/2024
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Last Update Date | 02/06/2026
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Provider Practice Location Address
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Address Line | 851 PROFESSIONAL PARK DR
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City | CLARKSVILLE
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State | TN
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Zip | 37040-5257
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Country | US
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Telephone | 931-542-2168
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Fax |
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Provider Business Mailing Address
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Address Line | 3747 HANNAH ELIZABETH CT
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City | CLARKSVILLE
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State | TN
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Zip | 37042-8631
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Country | US
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Telephone | 812-340-3197
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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 | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 8176
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License Number State | TN
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