MEDICARE: SHELBY HARTER MS, OTR/L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	OT.0007075	CO

General Provider Information

NPI Number	:	1386301265
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHELBY HARTER MS, OTR/L

Provider Business Mailing Address
First Line	:	713 E BASELINE RD
Second Line	:
City	:	LAFAYETTE
State	:	CO
Zip	:	80026-2414
Country	:	US
Telephone Number	:	951-316-6307
Fax Number	:

Provider Business Practice Location Address
First Line	:	1958 ELM ST RM 310
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80220-1247
Country	:	US
Telephone Number	:	951-316-6307
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/26/2021
Last Update Date	:	11/26/2021

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