Provider Demographics
NPI:1831989656
Name:RUSSELL, SHELBY BROOKE (MS, OTR/L)
Entity type:Individual
Prefix:
First Name:SHELBY
Middle Name:BROOKE
Last Name:RUSSELL
Suffix:
Gender:
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 SECOND ST
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:KY
Mailing Address - Zip Code:42501-2390
Mailing Address - Country:US
Mailing Address - Phone:606-677-1166
Mailing Address - Fax:
Practice Address - Street 1:303 SECOND ST
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42501-2390
Practice Address - Country:US
Practice Address - Phone:606-677-1166
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-07
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY244947225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist