MEDICARE: MRS. ANGELA LONNETTE SHELTON

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	224Z00000X	Occupational Therapy Assistant	210846	TX

General Provider Information

NPI Number	:	1649561937
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ANGELA LONNETTE SHELTON

Provider Business Mailing Address
First Line	:	1810 ARCHDALE DR
Second Line	:
City	:	CORPUS CHRISTI
State	:	TX
Zip	:	78416-2510
Country	:	US
Telephone Number	:	361-851-9245
Fax Number	:	361-851-9245

Provider Business Practice Location Address
First Line	:	1810 ARCHDALE DR
Second Line	:
City	:	CORPUS CHRISTI
State	:	TX
Zip	:	78416-2510
Country	:	US
Telephone Number	:	361-851-9245
Fax Number	:	361-851-9245

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

Provider Enumeration Date	:	04/21/2011
Last Update Date	:	04/21/2011

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