Provider Demographics
NPI:1972282994
Name:RICHARDSON, SHELBY (OTR/L, OTD)
Entity Type:Individual
Prefix:
First Name:SHELBY
Middle Name:
Last Name:RICHARDSON
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 1:235 3RD AVE N UNIT 649
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701-3387
Mailing Address - Country:US
Mailing Address - Phone:317-997-9417
Mailing Address - Fax:
Practice Address - Street 1:235 3RD AVE N UNIT 649
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-3387
Practice Address - Country:US
Practice Address - Phone:317-997-9417
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-17
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT24264225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist