Healthcare Provider Details

I. General information

NPI: 1306740451
Provider Name (Legal Business Name): CHRISTOPHER SHANE SHELTON OCCUPATIONAL THERAPI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5301 66TH ST
LUBBOCK TX
79424-1369
US

IV. Provider business mailing address

5819 111TH ST
LUBBOCK TX
79424-3889
US

V. Phone/Fax

Practice location:
  • Phone: 806-798-9871
  • Fax:
Mailing address:
  • Phone: 806-787-8222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number108601
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: