Individual
TERESA LYNN SHAW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR L
Contact information
Practice address
2705 ENLOE ST, HUDSON, WI 54016-8173
(715) 386-2128
(715) 386-6119
Mailing address
1716 ARLINGTON AVE E, SAINT PAUL, MN 55106-1507
(651) 776-2291
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
4235
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
40445000
—
WI
01
—
6405180
MEDICA
—
01
—
641671046996
PREFERRED ONE
—
01
—
98G79SH
BCBS MN
MN
01
—
HP47973
HEALTH PARTNERS
—
Enumeration date
06/05/2007
Last updated
07/09/2007
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