Provider Demographics
NPI:1225493950
Name:SOREN, SHAWN (MS, OT R/L)
Entity Type:Individual
Prefix:
First Name:SHAWN
Middle Name:
Last Name:SOREN
Suffix:
Gender:M
Credentials:MS, OT R/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:68 S BALTIC PL
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-5935
Mailing Address - Country:US
Mailing Address - Phone:208-587-8255
Mailing Address - Fax:
Practice Address - Street 1:68 S BALTIC PL
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-5935
Practice Address - Country:US
Practice Address - Phone:208-587-8255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-22
Last Update Date:2015-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID1555225X00000X, 225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics