Provider Demographics
NPI:1124583810
Name:SIMPSON, SHELLY RENEE (COTA)
Entity Type:Individual
Prefix:
First Name:SHELLY
Middle Name:RENEE
Last Name:SIMPSON
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 73 BOX 4975
Mailing Address - Street 2:
Mailing Address - City:DRURY
Mailing Address - State:MO
Mailing Address - Zip Code:65638
Mailing Address - Country:US
Mailing Address - Phone:513-594-9636
Mailing Address - Fax:
Practice Address - Street 1:211 DAVIS DR
Practice Address - Street 2:
Practice Address - City:WEST PLAINS
Practice Address - State:MO
Practice Address - Zip Code:65775-2242
Practice Address - Country:US
Practice Address - Phone:471-256-0798
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-06
Last Update Date:2019-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018005580224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant