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NPI Code Detail

MEDICARE: MS. LORI SHELLEY ATC

MEDICARE: MS. LORI SHELLEY ATC
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
12255A2300XAthletic Trainer000194OH

General Provider Information

NPI Number : 1083742712
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. LORI SHELLEY ATC
Provider Business Mailing Address
First Line : 8240 RUSHTON DR
Second Line :
City : MENTOR
State : OH
Zip : 44060-2025
Country : US
Telephone Number : 440-205-1714
Fax Number : 440-205-1792
Provider Business Practice Location Address
First Line : 7533 CENTER ST
Second Line :
City : MENTOR
State : OH
Zip : 44060-6001
Country : US
Telephone Number : 440-205-1714
Fax Number : 440-205-1792
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/02/2007
Last Update Date : 06/26/2013

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Directions to “ MS. LORI SHELLEY ATC” Practice Location

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