Individual
SHAWN TYLER BUSTOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OT
Contact information
Practice address
8409 S WESTERN AVE, OKLAHOMA CITY, OK 73139-9211
(405) 616-0113
(405) 616-0116
Mailing address
8409 S WESTERN AVE, OKLAHOMA CITY, OK 73139-9211
(405) 616-0113
(405) 616-0116
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
782
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100631740B
—
OK
Enumeration date
06/12/2006
Last updated
09/29/2009
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