Provider Demographics
NPI:1306180153
Name:BLAIR, SHAUNDRA JANELLE (OTD, OTR/L, CDP)
Entity Type:Individual
Prefix:MRS
First Name:SHAUNDRA
Middle Name:JANELLE
Last Name:BLAIR
Suffix:
Gender:F
Credentials:OTD, OTR/L, CDP
Other - Prefix:MS
Other - First Name:SHAUNDRA
Other - Middle Name:JANELLE
Other - Last Name:GARRETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7007 TAMARACK CT
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45315-7900
Mailing Address - Country:US
Mailing Address - Phone:567-204-0417
Mailing Address - Fax:
Practice Address - Street 1:7007 TAMARACK CT
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:OH
Practice Address - Zip Code:45315-7900
Practice Address - Country:US
Practice Address - Phone:567-204-0417
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-18
Last Update Date:2019-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT.007342225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist