Shelby Nicole Mondloch, OTA/L

Primary specialty

Occupational Therapy AssistantTaxonomy code 224Z00000X

License

1211 Issued in OK

Practice address

4300 S Juniper PL
Broken Arrow, OK 74011-2832

Phone

(918) 259-4420

NPI assigned

Jul 9, 2019

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

Other names 1

• Shelby Nicole Franks Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1562630400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1562630400000",
    "number": "1831741032",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14206 S WINSTON AVE",
            "city": "BIXBY",
            "state": "OK",
            "postal_code": "740083773",
            "telephone_number": "918-688-4205"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4300 S JUNIPER PL",
            "city": "BROKEN ARROW",
            "state": "OK",
            "postal_code": "740112832",
            "telephone_number": "918-259-4420"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1165 Brenner Rd",
            "address_purpose": "LOCATION",
            "city": "Sapulpa",
            "state": "OK",
            "postal_code": "740666141",
            "country_code": "US",
            "telephone_number": "818-224-0600",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MONDLOCH",
        "first_name": "SHELBY",
        "middle_name": "NICOLE",
        "credential": "OTA/L",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-07-09",
        "last_updated": "2019-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "224Z00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapy Assistant",
            "state": "OK",
            "license": "1211",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SHELBY",
            "last_name": "FRANKS",
            "middle_name": "NICOLE",
            "credential": "OTA/L",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Occupational Therapy Assistant in Broken Arrow, OK
• Providers in Broken Arrow, 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 9, 2019; 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.