Provider Demographics
NPI:1407335037
Name:BLAIR, SHAWNA MICHELLE (COTA)
Entity Type:Individual
Prefix:
First Name:SHAWNA
Middle Name:MICHELLE
Last Name:BLAIR
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 1:20490 FM 1018
Mailing Address - Street 2:
Mailing Address - City:LYFORD
Mailing Address - State:TX
Mailing Address - Zip Code:78569-2229
Mailing Address - Country:US
Mailing Address - Phone:956-535-2934
Mailing Address - Fax:
Practice Address - Street 1:1814 ATRIUM PLACE DR
Practice Address - Street 2:
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550-2583
Practice Address - Country:US
Practice Address - Phone:956-230-2300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-14
Last Update Date:2018-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX208971224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant