Provider Demographics
NPI:1154981298
Name:O'CONNOR, SHELBY
Entity type:Individual
Prefix:
First Name:SHELBY
Middle Name:
Last Name:O'CONNOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHELBY
Other - Middle Name:
Other - Last Name:ROTHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:50416 HORSESHOE RD
Mailing Address - Street 2:
Mailing Address - City:WOLBACH
Mailing Address - State:NE
Mailing Address - Zip Code:68882-7033
Mailing Address - Country:US
Mailing Address - Phone:308-750-1623
Mailing Address - Fax:
Practice Address - Street 1:50416 HORSESHOE RD
Practice Address - Street 2:
Practice Address - City:WOLBACH
Practice Address - State:NE
Practice Address - Zip Code:68882-7033
Practice Address - Country:US
Practice Address - Phone:308-750-1623
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-20
Last Update Date:2021-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2330225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist