Provider Demographics
NPI:1992968085
Name:SHELTON, ROBERTA A (OTR)
Entity type:Individual
Prefix:MRS
First Name:ROBERTA
Middle Name:A
Last Name:SHELTON
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:190 EAST STATE HIGHWAY 136
Mailing Address - Street 2:
Mailing Address - City:CALHOUN
Mailing Address - State:KY
Mailing Address - Zip Code:42327
Mailing Address - Country:US
Mailing Address - Phone:270-273-3750
Mailing Address - Fax:270-273-3750
Practice Address - Street 1:515 GREEN DRIVE
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:KY
Practice Address - Zip Code:42345
Practice Address - Country:US
Practice Address - Phone:270-273-3750
Practice Address - Fax:270-273-3750
Is Sole Proprietor?:No
Enumeration Date:2008-07-08
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYR2328225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist