Individual
KRISTI SHAW
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
22 PORTWEST CT, SAINT CHARLES, MO 63303-5985
(636) 916-0022
(636) 916-0023
Mailing address
22 PORTWEST CT, SAINT CHARLES, MO 63303-5985
(636) 916-0022
(636) 916-0023
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
2000175708
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2000175708
STATE LICENSE NUMBER
MO
Enumeration date
10/21/2009
Last updated
10/21/2009
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