Provider Demographics
NPI:1558975854
Name:TASKER, SHAY LYNN RAE (OTR/L)
Entity Type:Individual
Prefix:
First Name:SHAY LYNN
Middle Name:RAE
Last Name:TASKER
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 1:2177 SWANTON RD
Mailing Address - Street 2:
Mailing Address - City:SWANTON
Mailing Address - State:MD
Mailing Address - Zip Code:21561-1009
Mailing Address - Country:US
Mailing Address - Phone:301-616-2327
Mailing Address - Fax:
Practice Address - Street 1:4767 FRANKFORT HWY
Practice Address - Street 2:
Practice Address - City:RIDGELEY
Practice Address - State:WV
Practice Address - Zip Code:26753-7772
Practice Address - Country:US
Practice Address - Phone:304-738-4045
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-03
Last Update Date:2020-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD09107225X00000X
WV2123225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist