Provider Demographics
NPI:1629575675
Name:PAEZ, SHELBY (OTR/L)
Entity Type:Individual
Prefix:
First Name:SHELBY
Middle Name:
Last Name:PAEZ
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:SHELBY
Other - Middle Name:
Other - Last Name:GRATZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8309 BARBOUR RD
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23228-1925
Mailing Address - Country:US
Mailing Address - Phone:540-645-1675
Mailing Address - Fax:
Practice Address - Street 1:14366 SOMMERVILLE CT
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23113-6838
Practice Address - Country:US
Practice Address - Phone:804-601-6010
Practice Address - Fax:804-601-4774
Is Sole Proprietor?:No
Enumeration Date:2018-04-06
Last Update Date:2020-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119-007618225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist