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NPI Code Detail

MEDICARE: SHANTRELL SAM

MEDICARE: SHANTRELL SAM
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 Therapist218606TX
2106S00000XBehavior Technician

General Provider Information

NPI Number : 1982427720
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHANTRELL SAM
Provider Business Mailing Address
First Line : 7500 SAN FELIPE ST STE 990
Second Line :
City : HOUSTON
State : TX
Zip : 77063-1708
Country : US
Telephone Number : 866-610-0580
Fax Number : 866-611-1558
Provider Business Practice Location Address
First Line : 2743 SMITH RANCH RD STE 704
Second Line :
City : PEARLAND
State : TX
Zip : 77584-5218
Country : US
Telephone Number : 281-258-4447
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/31/2024
Last Update Date : 02/28/2025

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Directions to “ SHANTRELL SAM ” Practice Location

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