Shelly Ranae Waddle, OTA

Primary specialty

Occupational Therapy AssistantTaxonomy code 224Z00000X

License

473 Issued in OK

Practice address

1013 SW 128TH St
Oklahoma City, OK 73170-6951

Phone

(405) 691-3418

NPI assigned

Jul 2, 2007

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1183334400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1730386756",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1013 S.W. 128 ST",
            "city": "OKC",
            "state": "OK",
            "postal_code": "73170"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1013 SW 128TH ST",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731706951",
            "telephone_number": "405-691-3418"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WADDLE",
        "first_name": "SHELLY",
        "middle_name": "RANAE",
        "credential": "OTA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-07-02",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "224Z00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapy Assistant",
            "state": "OK",
            "license": "473",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• W. Stanley Muenzler, M.D., Inc.
• W.a. Clark, D.D.S., P.L.L.C.
• W.G. Leslie DDS, Inc
• Kamree Wackler
• Amelia Waddle, PTA
• Aaron Clay Wade, PA-C
• Adama N Wade, CD,CPD
• Brent A Wade Sr.
• David Glen Wade, DPM
• Donna Lee Wade, LPC, LADC

• Occupational Therapy Assistant in Oklahoma City, OK
• Providers in Oklahoma City, OK by specialty
• Occupational Therapy Assistant in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.