Provider Demographics
NPI:1538271986
Name:REDDEN, SHELLEY COLEMAN (OT)
Entity type:Individual
Prefix:
First Name:SHELLEY
Middle Name:COLEMAN
Last Name:REDDEN
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 GREYSTONE SQ
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-3580
Mailing Address - Country:US
Mailing Address - Phone:731-512-0302
Mailing Address - Fax:731-512-0319
Practice Address - Street 1:1000 GREYSTONE SQ
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-3580
Practice Address - Country:US
Practice Address - Phone:731-512-0302
Practice Address - Fax:731-512-0319
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2011-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2903225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist