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General NPI Number Information
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NPI Number | 1881465417
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Entity Type | Individual
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Provider Name | SHELBY PHILYAW
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Gender | Female
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Dates
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Enumeration Date | 01/11/2024
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Last Update Date | 01/11/2024
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Provider Practice Location Address
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Address Line | 201 E 10TH ST
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City | SOUTH PITTSBURG
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State | TN
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Zip | 37380-1497
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Country | US
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Telephone | 423-463-8216
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Fax |
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Provider Business Mailing Address
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Address Line | 4435 SWEETENS COVE RD
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City | SOUTH PITTSBURG
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State | TN
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Zip | 37380-6429
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Country | US
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Telephone | 423-463-8216
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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 |
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License Number State |
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