Provider Demographics
NPI:1073397857
Name:MINCKS, SHELBY (OTR/L)
Entity Type:Individual
Prefix:
First Name:SHELBY
Middle Name:
Last Name:MINCKS
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2245 GRAY ST
Mailing Address - Street 2:
Mailing Address - City:EDGEWATER
Mailing Address - State:CO
Mailing Address - Zip Code:80214-1138
Mailing Address - Country:US
Mailing Address - Phone:740-334-0258
Mailing Address - Fax:
Practice Address - Street 1:940 FILLMORE ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80206-3852
Practice Address - Country:US
Practice Address - Phone:303-399-1800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-22
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist