Provider Demographics
NPI:1760963375
Name:SHELTON, TERRI (OTA)
Entity Type:Individual
Prefix:
First Name:TERRI
Middle Name:
Last Name:SHELTON
Suffix:
Gender:F
Credentials:OTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20488 N FM 709
Mailing Address - Street 2:
Mailing Address - City:HUBBARD
Mailing Address - State:TX
Mailing Address - Zip Code:76648-2925
Mailing Address - Country:US
Mailing Address - Phone:903-654-0146
Mailing Address - Fax:
Practice Address - Street 1:300 W HAVEN ST
Practice Address - Street 2:
Practice Address - City:WEST
Practice Address - State:TX
Practice Address - Zip Code:76691-1011
Practice Address - Country:US
Practice Address - Phone:254-826-5354
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-22
Last Update Date:2018-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX205333224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant