Provider Demographics
NPI:1467579920
Name:WESEN, SHAUN MARIE (OTR-L)
Entity Type:Individual
Prefix:MS
First Name:SHAUN
Middle Name:MARIE
Last Name:WESEN
Suffix:
Gender:F
Credentials:OTR-L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4614 CHUCKANUT DR
Mailing Address - Street 2:
Mailing Address - City:BOW
Mailing Address - State:WA
Mailing Address - Zip Code:98232-9264
Mailing Address - Country:US
Mailing Address - Phone:360-766-6850
Mailing Address - Fax:
Practice Address - Street 1:320 PACIFIC PL
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98273-5463
Practice Address - Country:US
Practice Address - Phone:360-416-7570
Practice Address - Fax:360-416-7580
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT00000623225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics