Provider Demographics
NPI:1679749063
Name:NEELY-OTTS, SHAWN MICHELE (COTA)
Entity Type:Individual
Prefix:MRS
First Name:SHAWN
Middle Name:MICHELE
Last Name:NEELY-OTTS
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12709 BELLA PKWY
Mailing Address - Street 2:
Mailing Address - City:MANOR
Mailing Address - State:TX
Mailing Address - Zip Code:78653-4597
Mailing Address - Country:US
Mailing Address - Phone:512-382-5306
Mailing Address - Fax:
Practice Address - Street 1:12709 BELLA PKWY
Practice Address - Street 2:
Practice Address - City:MANOR
Practice Address - State:TX
Practice Address - Zip Code:78653-4597
Practice Address - Country:US
Practice Address - Phone:512-382-5306
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-05
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX208922224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant