Provider Demographics
NPI:1134425374
Name:WOLFE, SHELLEY RAE (COTA)
Entity type:Individual
Prefix:
First Name:SHELLEY
Middle Name:RAE
Last Name:WOLFE
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3100 PETERS COLONY RD
Mailing Address - Street 2:
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75022-2949
Mailing Address - Country:US
Mailing Address - Phone:940-781-0528
Mailing Address - Fax:
Practice Address - Street 1:2620 SCRIPTURE ST
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76201-4315
Practice Address - Country:US
Practice Address - Phone:940-297-6500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-06
Last Update Date:2011-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX208683224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant