Provider Demographics
NPI:1598548539
Name:COSTABILE, SHELBY MARIE (OT)
Entity Type:Individual
Prefix:
First Name:SHELBY
Middle Name:MARIE
Last Name:COSTABILE
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:11703 HUEBNER RD # 106-207
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78230-1201
Mailing Address - Country:US
Mailing Address - Phone:210-793-0877
Mailing Address - Fax:210-568-4046
Practice Address - Street 1:3026 HILLCREST DR # 200
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78201-7006
Practice Address - Country:US
Practice Address - Phone:210-793-8077
Practice Address - Fax:210-568-4046
Is Sole Proprietor?:No
Enumeration Date:2023-08-15
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX123710225X00000X, 225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist