Provider Demographics
NPI:1598995516
Name:SHORES MASEK, REBECCA LEE (COTA/L)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:LEE
Last Name:SHORES MASEK
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:MS
Other - First Name:REBECCA
Other - Middle Name:LEE
Other - Last Name:SCHWIETERMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA/L, KYA5571
Mailing Address - Street 1:201 KIMBERLY LN
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:41097-9458
Mailing Address - Country:US
Mailing Address - Phone:859-824-7803
Mailing Address - Fax:
Practice Address - Street 1:201 KIMBERLY LN
Practice Address - Street 2:
Practice Address - City:WILLIAMSTOWN
Practice Address - State:KY
Practice Address - Zip Code:41097-9458
Practice Address - Country:US
Practice Address - Phone:859-824-7803
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-24
Last Update Date:2015-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-A5571224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant