Provider Demographics
NPI:1588157218
Name:MITCHELL, SHELBY LEE (OTD, OTR)
Entity type:Individual
Prefix:
First Name:SHELBY
Middle Name:LEE
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:OTD, OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1986 E 250 S
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:IN
Mailing Address - Zip Code:47949-8008
Mailing Address - Country:US
Mailing Address - Phone:765-585-9489
Mailing Address - Fax:
Practice Address - Street 1:2600 FERRY ST
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47904-3055
Practice Address - Country:US
Practice Address - Phone:765-838-7472
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-07
Last Update Date:2018-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN402024225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist