Provider Demographics
NPI:1770251076
Name:SHIELDS, BILLY RAY (OTA)
Entity Type:Individual
Prefix:MR
First Name:BILLY
Middle Name:RAY
Last Name:SHIELDS
Suffix:
Gender:M
Credentials:OTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2244 E SHAWNEE RD
Mailing Address - Street 2:
Mailing Address - City:MUSKOGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74403-1443
Mailing Address - Country:US
Mailing Address - Phone:918-684-9999
Mailing Address - Fax:888-663-4223
Practice Address - Street 1:2244 E SHAWNEE RD
Practice Address - Street 2:
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74403-1443
Practice Address - Country:US
Practice Address - Phone:918-684-9999
Practice Address - Fax:888-663-4223
Is Sole Proprietor?:No
Enumeration Date:2021-09-01
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1281224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant