Active NPI
Shelley R Holland, CTRS
- Recreation Therapist
- Long Beach, MS
National Provider Identifier
1669832747
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Recreation Therapist
- License
- 66563
- Practice address
- 730 E Beach Blvd # 5128
Long Beach, MS 39560-6259 - Phone
- (228) 214-3319
- NPI assigned
- Mar 2, 2016
- Last updated
- Mar 2, 2016
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Recreation Therapist | 225800000X | 66563 | MS | Primary |
Addresses
Primary practice location
730 E Beach Blvd # 5128
Long Beach, MS 39560-6259
Mailing address
730 E Beach Blvd # 5128
Long Beach, MS 39560-6259
Phone (228) 214-3319
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 66563 | MS | MD | Recreation Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1456876800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1456876800000",
"number": "1669832747",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "730 E BEACH BLVD # 5128",
"city": "LONG BEACH",
"state": "MS",
"postal_code": "395606259",
"telephone_number": "228-214-3319"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "730 E BEACH BLVD # 5128",
"city": "LONG BEACH",
"state": "MS",
"postal_code": "395606259",
"telephone_number": "228-214-3319"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HOLLAND",
"first_name": "SHELLEY",
"middle_name": "R",
"name_prefix": "Ms.",
"credential": "CTRS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-03-02",
"last_updated": "2016-03-02",
"status": "A"
},
"taxonomies": [
{
"code": "225800000X",
"taxonomy_group": "",
"desc": "Recreation Therapist",
"state": "MS",
"license": "66563",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Long Beach, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 2, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.