Provider Demographics
NPI:1003168766
Name:BRIGGS, SHADONDA EVETTE (COTA/L)
Entity Type:Individual
Prefix:MRS
First Name:SHADONDA
Middle Name:EVETTE
Last Name:BRIGGS
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 SOUR ST
Mailing Address - Street 2:
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801-3928
Mailing Address - Country:US
Mailing Address - Phone:304-719-9309
Mailing Address - Fax:
Practice Address - Street 1:101 SOUR ST
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-3928
Practice Address - Country:US
Practice Address - Phone:304-719-9309
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-04
Last Update Date:2012-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVC1614224Z00000X
NC7219224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant