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Individual

KELLY K SHOUP

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
17480 DALLAS PKWY STE 221, DALLAS, TX 75287-7361
(469) 291-8500
Mailing address
5220 SPRING VALLEY RD STE 300, DALLAS, TX 75254-1944
(469) 291-8500

Taxonomy

Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
112049
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
112049
OT
TX
Enumeration date
07/23/2025
Last updated
07/23/2025
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