Provider Demographics
NPI:1467220475
Name:BLANTON, SHELBY (OTR)
Entity Type:Individual
Prefix:
First Name:SHELBY
Middle Name:
Last Name:BLANTON
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 MOORESBURG SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:MOORESBURG
Mailing Address - State:TN
Mailing Address - Zip Code:37811-5426
Mailing Address - Country:US
Mailing Address - Phone:703-447-3192
Mailing Address - Fax:
Practice Address - Street 1:2999 OLYMPUS BLVD
Practice Address - Street 2:
Practice Address - City:COPPELL
Practice Address - State:TX
Practice Address - Zip Code:75019-0122
Practice Address - Country:US
Practice Address - Phone:866-871-8519
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-19
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist