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NPI Code Detail

MEDICARE: SHELBY BLANTON OTR

MEDICARE: SHELBY BLANTON OTR
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
1225X00000XOccupational Therapist

General Provider Information

NPI Number : 1467220475
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHELBY BLANTON OTR
Provider Business Mailing Address
First Line : 140 MOORESBURG SPRINGS RD
Second Line :
City : MOORESBURG
State : TN
Zip : 37811-5426
Country : US
Telephone Number : 703-447-3192
Fax Number :
Provider Business Practice Location Address
First Line : 2999 OLYMPUS BLVD
Second Line :
City : COPPELL
State : TX
Zip : 75019-0122
Country : US
Telephone Number : 866-871-8519
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/19/2023
Last Update Date : 12/19/2023

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Directions to “ SHELBY BLANTON OTR” Practice Location

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