Provider Demographics
NPI:1447447206
Name:NYREN, SHELLEY L (OTR)
Entity type:Individual
Prefix:MRS
First Name:SHELLEY
Middle Name:L
Last Name:NYREN
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:975 CORBIN AVE
Mailing Address - Street 2:
Mailing Address - City:NEW BRITAIN
Mailing Address - State:CT
Mailing Address - Zip Code:06052-1243
Mailing Address - Country:US
Mailing Address - Phone:860-229-3707
Mailing Address - Fax:860-832-9310
Practice Address - Street 1:975 CORBIN AVE
Practice Address - Street 2:
Practice Address - City:NEW BRITAIN
Practice Address - State:CT
Practice Address - Zip Code:06052-1243
Practice Address - Country:US
Practice Address - Phone:860-229-3707
Practice Address - Fax:860-832-9310
Is Sole Proprietor?:No
Enumeration Date:2007-09-26
Last Update Date:2007-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000979225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist