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General NPI Number Information
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NPI Number | 1366309189
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Entity Type | Individual
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Provider Name | SHELBY TAYLOR GOTTULA
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Gender | Female
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Dates
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Enumeration Date | 01/05/2026
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Last Update Date | 01/05/2026
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Provider Practice Location Address
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Address Line | 2307 SE B ST STE 1
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City | BENTONVILLE
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State | AR
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Zip | 72712-5314
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Country | US
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Telephone | 479-802-4798
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Fax |
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Provider Business Mailing Address
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Address Line | 4000 S DIXIELAND RD APT B302
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City | ROGERS
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State | AR
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Zip | 72758-0027
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Country | US
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Telephone | 479-269-1814
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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 | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 106S00000X
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License Number State | AR
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