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NPI Code Detail

MEDICARE: SHELLEY JANECKA OTR

MEDICARE: SHELLEY JANECKA 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
1225XH1200XHand Occupational Therapist
2225XN1300XNeurorehabilitation Occupational Therapist
3225XP0200XPediatric Occupational Therapist118968TX
4225X00000XOccupational Therapist118968TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1118968OTHERTXOT LICENSE
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1730680075
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHELLEY JANECKA OTR
Provider Business Mailing Address
First Line : 3052 FM 1383
Second Line :
City : SCHULENBURG
State : TX
Zip : 78956-5736
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 411 SUMMIT ST
Second Line :
City : SCHULENBURG
State : TX
Zip : 78956-1532
Country : US
Telephone Number : 979-743-2108
Fax Number : 979-743-2109
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/22/2018
Last Update Date : 03/29/2022

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Directions to “ SHELLEY JANECKA OTR” Practice Location

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