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General NPI Number Information
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NPI Number | 1952182974
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Entity Type | Individual
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Provider Name | SHELBY HALLER OTR, OTD
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Gender | Female
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Dates
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Enumeration Date | 10/06/2023
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Last Update Date | 10/06/2023
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Provider Practice Location Address
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Address Line | 800 RIVERWOOD CT STE 110
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City | CONROE
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State | TX
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Zip | 77304-2824
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Country | US
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Telephone | 936-391-8266
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Fax |
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Provider Business Mailing Address
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Address Line | 23200 FOREST NORTH DR APT 807
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City | KINGWOOD
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State | TX
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Zip | 77339-2097
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Country | US
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Telephone | 281-608-0301
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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 | 124107
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License Number State | TX
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