Provider Demographics
NPI:1205839628
Name:SHORE, KAY (OT)
Entity Type:Individual
Prefix:
First Name:KAY
Middle Name:
Last Name:SHORE
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 CORTEZ RD
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS VILLAGE
Mailing Address - State:AR
Mailing Address - Zip Code:71909-6101
Mailing Address - Country:US
Mailing Address - Phone:501-922-2000
Mailing Address - Fax:501-922-4068
Practice Address - Street 1:121 CORTEZ RD
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS VILLAGE
Practice Address - State:AR
Practice Address - Zip Code:71909-6101
Practice Address - Country:US
Practice Address - Phone:501-922-2000
Practice Address - Fax:501-922-4068
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2009-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROTR2053225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ000227851OtherAZ STATE DES CMDP
AZAZ0295990OtherBCBS AZ
AZ64-00187OtherUNITED HEALTH PLAN
AZ189208700OtherDOL OWCP
AZF02383OtherPHOENIX HEALTH PLAN
AZ1Z6798OtherHEALTH NET
AZ26144OtherMEDICARE GROUP ID
AZ643800Medicaid
AZ64-00187OtherUNITED HEALTH PLAN