Provider Demographics
NPI:1487985909
Name:SHELTON, HALLIE JANEE (MOTR/L)
Entity type:Individual
Prefix:
First Name:HALLIE
Middle Name:JANEE
Last Name:SHELTON
Suffix:
Gender:F
Credentials:MOTR/L
Other - Prefix:
Other - First Name:HALLIE
Other - Middle Name:JANEE
Other - Last Name:MICHAEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:505 S MAIN ST STE 249
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88001-1243
Mailing Address - Country:US
Mailing Address - Phone:575-527-5823
Mailing Address - Fax:575-527-5886
Practice Address - Street 1:505 S MAIN ST STE 249
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88001-1243
Practice Address - Country:US
Practice Address - Phone:575-527-5823
Practice Address - Fax:575-527-5886
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-22
Last Update Date:2019-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2667225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist