Provider Demographics
NPI:1750059556
Name:SMITH, SHELBY STANALAND (OTR/L)
Entity type:Individual
Prefix:
First Name:SHELBY
Middle Name:STANALAND
Last Name:SMITH
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:SHELBY
Other - Middle Name:O
Other - Last Name:STANALAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4847 PROMENADE PKWY STE 102
Mailing Address - Street 2:
Mailing Address - City:BESSEMER
Mailing Address - State:AL
Mailing Address - Zip Code:35022-7310
Mailing Address - Country:US
Mailing Address - Phone:205-481-9012
Mailing Address - Fax:205-481-9014
Practice Address - Street 1:4847 PROMENADE PKWY STE 102
Practice Address - Street 2:
Practice Address - City:BESSEMER
Practice Address - State:AL
Practice Address - Zip Code:35022-7310
Practice Address - Country:US
Practice Address - Phone:205-481-9012
Practice Address - Fax:205-481-9014
Is Sole Proprietor?:No
Enumeration Date:2021-09-06
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5516225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist