=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053497677
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RICHARD L SHORKEY EDUCATION & REHABILITATION CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/27/2006
-----------------------------------------------------
Last Update Date | 02/14/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 855 S 8TH ST
-----------------------------------------------------
City | BEAUMONT
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77701
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 409-838-6568
-----------------------------------------------------
Fax | 409-838-1337
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 855 S 8TH ST
-----------------------------------------------------
City | BEAUMONT
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77701
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 409-838-6568
-----------------------------------------------------
Fax | 409-838-1337
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | INSURANCE/BILLING ADMIN
-----------------------------------------------------
Name | RE DEANA DEANA SHAVER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 409-838-6568
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103K00000X
-----------------------------------------------------
Taxonomy Name | Behavior Analyst
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------