MEDICARE: SHELLENA ATKINS SNODGRASS

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	225X00000X	Occupational Therapist	OT0000002000	TN

General Provider Information

NPI Number	:	1427340785
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHELLENA ATKINS SNODGRASS

Provider Business Mailing Address
First Line	:	2473 CRESCENT LAKE PL
Second Line	:
City	:	JOHNSON CITY
State	:	TN
Zip	:	37615-4592
Country	:	US
Telephone Number	:	423-863-1162
Fax Number	:

Provider Business Practice Location Address
First Line	:	302 WESLEY ST
Second Line	:	SUITE 8
City	:	JOHNSON CITY
State	:	TN
Zip	:	37601-1740
Country	:	US
Telephone Number	:	423-282-1700
Fax Number	:	423-282-9319

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

Provider Enumeration Date	:	05/04/2011
Last Update Date	:	12/09/2011

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