Individual
JENE R SHAW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR
Contact information
Practice address
5790 DENLINGER RD, DAYTON, OH 45426-1838
(937) 837-5581
Mailing address
1940 LINCOLN RD, MEDWAY, OH 45341-1567
(937) 901-1798
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT011075
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
OT011075
OHIO OTPTAT BOARD (OCCUPATIONAL THERAPY LICENSE)
OH
Enumeration date
07/16/2020
Last updated
07/16/2020
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