Provider Demographics
NPI:1114692464
Name:SHAW, KATRINA JEAN (COTA/L)
Entity Type:Individual
Prefix:
First Name:KATRINA
Middle Name:JEAN
Last Name:SHAW
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 1:1501 SW MULVANE ST
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66604-2715
Mailing Address - Country:US
Mailing Address - Phone:785-554-0003
Mailing Address - Fax:785-231-5903
Practice Address - Street 1:634 SW MULVANE ST
Practice Address - Street 2:STE 404
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66606-1678
Practice Address - Country:US
Practice Address - Phone:785-295-8045
Practice Address - Fax:785-231-5903
Is Sole Proprietor?:No
Enumeration Date:2021-08-10
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS18-01713224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant