Provider Demographics
NPI:1881101160
Name:LEDERMAN, SHELBY A (OT)
Entity type:Individual
Prefix:
First Name:SHELBY
Middle Name:A
Last Name:LEDERMAN
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10308 CRIMSON TREE CT
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-2509
Mailing Address - Country:US
Mailing Address - Phone:443-878-6634
Mailing Address - Fax:
Practice Address - Street 1:2611 OLNEY SANDY SPRING RD
Practice Address - Street 2:
Practice Address - City:OLNEY
Practice Address - State:MD
Practice Address - Zip Code:20832-1604
Practice Address - Country:US
Practice Address - Phone:301-570-2611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-08
Last Update Date:2018-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD07507225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist