Provider Demographics
NPI:1538662473
Name:COBB, SHELBY (OTR/L)
Entity Type:Individual
Prefix:
First Name:SHELBY
Middle Name:
Last Name:COBB
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:SHELBY
Other - Middle Name:
Other - Last Name:HATZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3515 E LOMBARD ST APT C211
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65809-1441
Mailing Address - Country:US
Mailing Address - Phone:417-848-7441
Mailing Address - Fax:
Practice Address - Street 1:1545 E PRIMROSE ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-7927
Practice Address - Country:US
Practice Address - Phone:417-811-9500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-16
Last Update Date:2018-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018006789225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics