Provider Demographics
NPI:1831688043
Name:SHELTON, HAYDEN (OTR/L)
Entity type:Individual
Prefix:
First Name:HAYDEN
Middle Name:
Last Name:SHELTON
Suffix:
Gender:M
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 1:748 JOHNSON RD
Mailing Address - Street 2:
Mailing Address - City:LUVERNE
Mailing Address - State:AL
Mailing Address - Zip Code:36049-6002
Mailing Address - Country:US
Mailing Address - Phone:334-268-3173
Mailing Address - Fax:
Practice Address - Street 1:1600 WALLACE BLVD
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106
Practice Address - Country:US
Practice Address - Phone:806-212-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-02
Last Update Date:2018-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX118999225X00000X
OR398201225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist