Individual
SHELLY VAN AUDENHOVE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
404 RACQUET CLUB BLVD, BEDFORD, TX 76022-6408
(682) 738-3056
Mailing address
3904 CLAYTON RD W, FORT WORTH, TX 76116-7926
(469) 212-3455
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
216931
TX
Other
Enumeration date
08/30/2021
Last updated
12/14/2022
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