Provider Demographics
NPI:1851848717
Name:FOX, SHELBY L (MS, OTR/L)
Entity Type:Individual
Prefix:
First Name:SHELBY
Middle Name:L
Last Name:FOX
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5244 ROME TABERG RD
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:NY
Mailing Address - Zip Code:13440-1724
Mailing Address - Country:US
Mailing Address - Phone:315-725-0020
Mailing Address - Fax:
Practice Address - Street 1:5244 ROME TABERG RD
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:NY
Practice Address - Zip Code:13440-1724
Practice Address - Country:US
Practice Address - Phone:315-725-0020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-07
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019859225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist