MEDICARE: MRS. SHANA GILBERT 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
1	225XP0200X	Pediatric Occupational Therapist	107840	TX

General Provider Information

NPI Number	:	1528238748
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SHANA GILBERT OTR

Provider Business Mailing Address
First Line	:	5318 PEPPERMINT DR
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78219-1452
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4502 CENTERVIEW
Second Line	:	SUITE 215
City	:	SAN ANTONIO
State	:	TX
Zip	:	78228-1318
Country	:	US
Telephone Number	:	210-733-7440
Fax Number	:	210-733-7570

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

Provider Enumeration Date	:	03/04/2008
Last Update Date	:	02/02/2011

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