Healthcare Provider Details

I. General information

NPI: 1902725336
Provider Name (Legal Business Name): SHELBY ANN SIPES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2026
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4610 25TH ST
COLUMBUS IN
47203-3239
US

IV. Provider business mailing address

4610 25TH ST
COLUMBUS IN
47203-3239
US

V. Phone/Fax

Practice location:
  • Phone: 812-314-2378
  • Fax: 812-373-7616
Mailing address:
  • Phone: 812-314-2378
  • Fax: 812-373-7616

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number31009105A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: