Basic Information
| Provider Information | |||||||||
| NPI: | 1427529528 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WIMBROUGH | ||||||||
| FirstName: | SHELBY | ||||||||
| MiddleName: | |||||||||
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| Credential: | MS, OTR/L | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | STARR | ||||||||
| OtherFirstName: | SHELBY | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 2852 ASPEN HILL RD | ||||||||
| Address2: | |||||||||
| City: | PARKVILLE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212342143 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4438128448 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 11201 PEPPER RD | ||||||||
| Address2: | |||||||||
| City: | HUNT VALLEY | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210311201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4105279505 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/16/2018 | ||||||||
| LastUpdateDate: | 12/16/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 08127 | MD | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.