Provider Demographics
NPI:1861640310
Name:SHULTS, LINDA (OT/CHT)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:SHULTS
Suffix:
Gender:F
Credentials:OT/CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3231 CAPITAL MEDICAL BLVD
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-4413
Mailing Address - Country:US
Mailing Address - Phone:850-219-1523
Mailing Address - Fax:850-201-3369
Practice Address - Street 1:3334 CAPITAL MEDICAL BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-8405
Practice Address - Country:US
Practice Address - Phone:850-219-1523
Practice Address - Fax:850-201-3369
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-08
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT13322225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1689704439OtherGROUP PRACTICE NPI
FL1689704439OtherMEDICARE PTAN
FL592831494OtherEMPLOYER IDENTIFICATION NUMBER