Individual
KAY SHORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OT
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OTR2053
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000227851
AZ STATE DES CMDP
AZ
01
—
189208700
DOL OWCP
AZ
01
—
1Z6798
HEALTH NET
AZ
01
—
26144
MEDICARE GROUP ID
AZ
01
—
64-00187
UNITED HEALTH PLAN
AZ
05
—
643800
—
AZ
01
—
AZ0295990
BCBS AZ
AZ
01
—
F02383
PHOENIX HEALTH PLAN
AZ
Enumeration date
05/31/2005
Last updated
02/21/2026
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