Provider Demographics
NPI:1407491715
Name:BOMAN, SHELBY MARIE (COTA/L)
Entity Type:Individual
Prefix:
First Name:SHELBY
Middle Name:MARIE
Last Name:BOMAN
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 YELTON CT APT E
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37211-3455
Mailing Address - Country:US
Mailing Address - Phone:205-712-5785
Mailing Address - Fax:
Practice Address - Street 1:119 W HIGH ST
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:TN
Practice Address - Zip Code:37190-1226
Practice Address - Country:US
Practice Address - Phone:615-563-5939
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-11
Last Update Date:2019-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3324224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant