Healthcare Provider Details

I. General information

NPI: 1023995958
Provider Name (Legal Business Name): SHELBY SEXTON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2025
Last Update Date: 08/20/2025
Certification Date: 08/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2701 CHESTNUT STATION CT
LOUISVILLE KY
40299-6395
US

IV. Provider business mailing address

4340 N MAPLE GROVE RD
BLOOMINGTON IN
47404-9541
US

V. Phone/Fax

Practice location:
  • Phone: 812-320-8521
  • Fax:
Mailing address:
  • Phone: 812-320-8521
  • Fax: 812-320-8521

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number31007237A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: