Provider Demographics
NPI:1790467694
Name:DECANN, SHELBY (OTR/L, OTD)
Entity Type:Individual
Prefix:
First Name:SHELBY
Middle Name:
Last Name:DECANN
Suffix:
Gender:F
Credentials:OTR/L, OTD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1811 W HAVASU WAY
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85248-5474
Mailing Address - Country:US
Mailing Address - Phone:320-241-2013
Mailing Address - Fax:
Practice Address - Street 1:990 W OCOTILLO RD
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85248-5708
Practice Address - Country:US
Practice Address - Phone:844-502-7996
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-01
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056014253225X00000X
AZOTH-008801225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist