Provider Demographics
NPI:1285870899
Name:CLARKSON, SHELLY KAY (OTR, CLT)
Entity type:Individual
Prefix:
First Name:SHELLY
Middle Name:KAY
Last Name:CLARKSON
Suffix:
Gender:F
Credentials:OTR, CLT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1216 HILLCREST DR
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75092-5507
Mailing Address - Country:US
Mailing Address - Phone:903-893-7457
Mailing Address - Fax:903-893-6671
Practice Address - Street 1:1216 HILLCREST DR
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75092
Practice Address - Country:US
Practice Address - Phone:903-893-7457
Practice Address - Fax:903-893-6671
Is Sole Proprietor?:No
Enumeration Date:2009-01-02
Last Update Date:2018-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX304725225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX111408402Medicaid
TX111408402Medicaid