Provider Demographics
NPI:1003029794
Name:RAPOPORT, SHELLY ANN (OTR)
Entity Type:Individual
Prefix:
First Name:SHELLY
Middle Name:ANN
Last Name:RAPOPORT
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:SHELLY
Other - Middle Name:ANN
Other - Last Name:EDWARDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:401 MORNINGSIDE DR
Mailing Address - Street 2:
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099-3343
Mailing Address - Country:US
Mailing Address - Phone:405-354-3980
Mailing Address - Fax:
Practice Address - Street 1:401 MORNINGSIDE DR
Practice Address - Street 2:
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099-3343
Practice Address - Country:US
Practice Address - Phone:405-354-3980
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK816225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist