Provider Demographics
NPI:1952182974
Name:HALLER, SHELBY (OTR, OTD)
Entity type:Individual
Prefix:
First Name:SHELBY
Middle Name:
Last Name:HALLER
Suffix:
Gender:F
Credentials:OTR, OTD
Other - Prefix:
Other - First Name:SHELBY
Other - Middle Name:
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:23200 FOREST NORTH DR APT 807
Mailing Address - Street 2:
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77339-2097
Mailing Address - Country:US
Mailing Address - Phone:281-608-0301
Mailing Address - Fax:
Practice Address - Street 1:800 RIVERWOOD CT STE 110
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-2824
Practice Address - Country:US
Practice Address - Phone:936-391-8266
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-06
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX124107225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist