Provider Demographics
NPI:1346405297
Name:DREPS, SHY M (COTA)
Entity Type:Individual
Prefix:
First Name:SHY
Middle Name:M
Last Name:DREPS
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 1:878 NW SOUTH SHORE DR
Mailing Address - Street 2:
Mailing Address - City:LAKE WAUKOMIS
Mailing Address - State:MO
Mailing Address - Zip Code:64151-1446
Mailing Address - Country:US
Mailing Address - Phone:816-587-5410
Mailing Address - Fax:
Practice Address - Street 1:878 NW SOUTH SHORE DR
Practice Address - Street 2:
Practice Address - City:LAKE WAUKOMIS
Practice Address - State:MO
Practice Address - Zip Code:64151-1446
Practice Address - Country:US
Practice Address - Phone:816-587-5410
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-21
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006018024224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant