Provider Demographics
NPI:1285861831
Name:VANDERLOO, SHAY VERONICA (COTA)
Entity Type:Individual
Prefix:
First Name:SHAY
Middle Name:VERONICA
Last Name:VANDERLOO
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3212 PARK LANE DR
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:NE
Mailing Address - Zip Code:68901-3334
Mailing Address - Country:US
Mailing Address - Phone:402-705-9908
Mailing Address - Fax:
Practice Address - Street 1:414 N WILLSON ST
Practice Address - Street 2:
Practice Address - City:BLUE HILL
Practice Address - State:NE
Practice Address - Zip Code:68930-3507
Practice Address - Country:US
Practice Address - Phone:402-705-9908
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-22
Last Update Date:2009-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE798224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant