Healthcare Provider Details

I. General information

NPI: 1588157218
Provider Name (Legal Business Name): SHELBY LEE MITCHELL OTD, OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2018
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 FERRY ST
LAFAYETTE IN
47904-3055
US

IV. Provider business mailing address

2600 FERRY ST
LAFAYETTE IN
47904-3055
US

V. Phone/Fax

Practice location:
  • Phone: 765-838-7472
  • Fax:
Mailing address:
  • Phone: 765-838-7516
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number402024
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: