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General NPI Number Information
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NPI Number | 1053087148
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Entity Type | Individual
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Provider Name | SHELLY MILLS OTA
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Gender | Female
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Dates
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Enumeration Date | 08/18/2021
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Last Update Date | 08/18/2021
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Provider Practice Location Address
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Address Line | 7057 US HIGHWAY 84 E
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City | GARRISON
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State | TX
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Zip | 75946-3750
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Country | US
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Telephone | 903-658-1418
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Fax | 855-232-8604
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Provider Business Mailing Address
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Address Line | PO BOX 542
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City | MOUNT ENTERPRISE
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State | TX
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Zip | 75681-0542
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Country | US
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Telephone | 903-658-1418
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Fax | 855-232-8604
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | 209725
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License Number State | TX
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