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Individual

SHIRLEY B SHAW

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
OT

Contact information

Practice address
2380 N 400 E, LOGAN, UT 84341-1749
(435) 787-9030
(435) 787-9033
Mailing address
2380 N 400 E, LOGAN, UT 84341-1749
(435) 787-9030
(435) 787-9033

Taxonomy

Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
3193264201
UT

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
D5392
UT
Enumeration date
04/17/2007
Last updated
07/08/2007
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