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General NPI Number Information
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NPI Number | 1366095234
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Entity Type | Individual
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Provider Name | SHELBEY ALLYN COSTELLO OTR/L
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Gender | Female
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Dates
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Enumeration Date | 07/19/2019
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Last Update Date | 07/19/2019
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Provider Practice Location Address
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Address Line | 736 MAIN ST
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City | BOONVILLE
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State | MO
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Zip | 65233-1656
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Country | US
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Telephone | 660-882-7474
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Fax |
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Provider Business Mailing Address
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Address Line | 4 BROADWAY VILLAGE DR APT H
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City | COLUMBIA
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State | MO
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Zip | 65201-8674
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Country | US
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Telephone | 417-389-2751
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Fax |
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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 | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 2019027108
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License Number State | MO
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