Provider Demographics
NPI:1578972311
Name:HUFFAKER, SHAWNA
Entity Type:Individual
Prefix:
First Name:SHAWNA
Middle Name:
Last Name:HUFFAKER
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:SHAWNA
Other - Middle Name:
Other - Last Name:HUFFAKER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OTR
Mailing Address - Street 1:12718 MOHAWK CIR
Mailing Address - Street 2:
Mailing Address - City:LEAWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66209-1717
Mailing Address - Country:US
Mailing Address - Phone:913-239-9883
Mailing Address - Fax:
Practice Address - Street 1:10617 W 92ND PL
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66214-2107
Practice Address - Country:US
Practice Address - Phone:816-686-3639
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-06
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014023116225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2014023116OtherMISSOURI BOARD OF OCCUPATIONAL THERAPY