Provider Demographics
NPI:1023880648
Name:FAIRMAN, SHELBY KATHRYN (OTR/L)
Entity type:Individual
Prefix:
First Name:SHELBY
Middle Name:KATHRYN
Last Name:FAIRMAN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:SHELBY
Other - Middle Name:KATHRYN
Other - Last Name:FAIRMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:1395 PEARCE HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:MARION CENTER
Mailing Address - State:PA
Mailing Address - Zip Code:15759-7508
Mailing Address - Country:US
Mailing Address - Phone:724-525-6192
Mailing Address - Fax:
Practice Address - Street 1:1395 PEARCE HOLLOW RD
Practice Address - Street 2:
Practice Address - City:MARION CENTER
Practice Address - State:PA
Practice Address - Zip Code:15759-7508
Practice Address - Country:US
Practice Address - Phone:724-525-6192
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-26
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC019282225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist