Provider Demographics
NPI:1225168347
Name:SHAW, ROSLYN MARIE (OT)
Entity Type:Individual
Prefix:
First Name:ROSLYN
Middle Name:MARIE
Last Name:SHAW
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 1:6501 PINE POINT DR
Mailing Address - Street 2:
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60477-2803
Mailing Address - Country:US
Mailing Address - Phone:708-927-9800
Mailing Address - Fax:708-231-0148
Practice Address - Street 1:6501 PINE POINT DR
Practice Address - Street 2:
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60477-2803
Practice Address - Country:US
Practice Address - Phone:708-927-9800
Practice Address - Fax:708-231-0148
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2010-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056006309225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist