Provider Demographics
NPI:1568866762
Name:COLVIN, SHELBY LANN (OTR/L)
Entity Type:Individual
Prefix:
First Name:SHELBY
Middle Name:LANN
Last Name:COLVIN
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:PO BOX 276
Mailing Address - Street 2:
Mailing Address - City:TAYLOR
Mailing Address - State:AR
Mailing Address - Zip Code:71861-0276
Mailing Address - Country:US
Mailing Address - Phone:870-904-2243
Mailing Address - Fax:
Practice Address - Street 1:415 FOREST STREET
Practice Address - Street 2:
Practice Address - City:TAYLOR
Practice Address - State:AR
Practice Address - Zip Code:71861-0276
Practice Address - Country:US
Practice Address - Phone:870-904-2243
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-16
Last Update Date:2014-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROTR2755225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist