Provider Demographics
NPI:1346018124
Name:SHEA-SHUMSKY, BECKETT (MSOT)
Entity Type:Individual
Prefix:
First Name:BECKETT
Middle Name:
Last Name:SHEA-SHUMSKY
Suffix:
Gender:F
Credentials:MSOT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 MADISON ST APT 3N
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60302-4427
Mailing Address - Country:US
Mailing Address - Phone:208-949-1552
Mailing Address - Fax:
Practice Address - Street 1:2700 N HAMPDEN CT
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614
Practice Address - Country:US
Practice Address - Phone:312-278-0022
Practice Address - Fax:888-975-3791
Is Sole Proprietor?:No
Enumeration Date:2023-12-12
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056015766225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist