Provider Demographics
NPI:1730680075
Name:JANECKA, SHELLEY (OTR)
Entity Type:Individual
Prefix:
First Name:SHELLEY
Middle Name:
Last Name:JANECKA
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3052 FM 1383
Mailing Address - Street 2:
Mailing Address - City:SCHULENBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78956-5736
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:411 SUMMIT ST
Practice Address - Street 2:
Practice Address - City:SCHULENBURG
Practice Address - State:TX
Practice Address - Zip Code:78956-1532
Practice Address - Country:US
Practice Address - Phone:979-743-2108
Practice Address - Fax:979-743-2109
Is Sole Proprietor?:No
Enumeration Date:2018-02-22
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225XH1200X, 225XN1300X
TX118968225XP0200X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
No225XN1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistNeurorehabilitation
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX118968OtherOT LICENSE
TX348743601Medicaid