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General NPI Number Information
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NPI Number | 1629714753
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Entity Type | Individual
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Provider Name | SHELBY ANN CORNELL OTR
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Gender | Female
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Dates
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Enumeration Date | 05/11/2022
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Last Update Date | 01/07/2024
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Provider Practice Location Address
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Address Line | 336 S POWERLINE RD
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City | DEERFIELD BEACH
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State | FL
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Zip | 33442-8105
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Country | US
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Telephone | 845-264-2072
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Fax |
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Provider Business Mailing Address
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Address Line | 305 W CORAL TRACE CIR
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City | DELRAY BEACH
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State | FL
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Zip | 33445-3603
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Country | US
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Telephone | 845-264-2072
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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 | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number | 026675
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 2081P0010X
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Taxonomy Name | Pediatric Rehabilitation Medicine Physician
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License Number | OT24550
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License Number State | FL
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