Active NPI
Shelley Henley, ITDS
- Developmental Therapist
- Fort Walton Beach, FL
National Provider Identifier
1255658761
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Developmental Therapist
- Practice address
- 681 Jerrells Ave
Fort Walton Beach, FL 32547-3187 - Phone
- (850) 797-0550
- NPI assigned
- Apr 23, 2010
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Developmental Therapist | 222Q00000X | Primary |
Addresses
Primary practice location
681 Jerrells Ave
Fort Walton Beach, FL 32547-3187
Mailing address
681 Jerrells Ave
Fort Walton Beach, FL 32547-3187
Phone (850) 797-0550
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PENDING | Medicaid | FL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1271980800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1271980800000",
"number": "1255658761",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "681 JERRELLS AVE",
"city": "FORT WALTON BEACH",
"state": "FL",
"postal_code": "325473187",
"telephone_number": "850-797-0550"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "681 JERRELLS AVE",
"city": "FORT WALTON BEACH",
"state": "FL",
"postal_code": "325473187",
"telephone_number": "850-797-0550"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HENLEY",
"first_name": "SHELLEY",
"name_prefix": "Ms.",
"credential": "ITDS",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2010-04-23",
"last_updated": "2010-04-23",
"status": "A"
},
"taxonomies": [
{
"code": "222Q00000X",
"taxonomy_group": "",
"desc": "Developmental Therapist",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "PENDING",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fort Walton Beach, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.