Provider Demographics
NPI:1992358287
Name:SLOVAK, SHELLY MARIE (OTR/L)
Entity Type:Individual
Prefix:
First Name:SHELLY
Middle Name:MARIE
Last Name:SLOVAK
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6402 RIPPLING HOLLOW DR
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77379-4229
Mailing Address - Country:US
Mailing Address - Phone:713-822-9134
Mailing Address - Fax:
Practice Address - Street 1:6402 RIPPLING HOLLOW DR
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77379-4229
Practice Address - Country:US
Practice Address - Phone:713-822-9134
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-16
Last Update Date:2019-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX107379225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist