MEDICARE: SHELBY TOLLETTE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies	140572	CO

General Provider Information

NPI Number	:	1053735357
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHELBY TOLLETTE

Provider Business Mailing Address
First Line	:	2351 OLIVE ST.
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80207-3540
Country	:	US
Telephone Number	:	303-394-9106
Fax Number	:	303-322-0423

Provider Business Practice Location Address
First Line	:	2351 OLIVE ST.
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80207-3540
Country	:	US
Telephone Number	:	303-394-9106
Fax Number	:	303-322-0423

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/07/2014
Last Update Date	:	02/04/2015

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Directions to “ SHELBY TOLLETTE ” Practice Location

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