Provider Demographics
NPI:1609221670
Name:WASHABAUGH, SHANA DEE (OT)
Entity Type:Individual
Prefix:
First Name:SHANA
Middle Name:DEE
Last Name:WASHABAUGH
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:SHANA
Other - Middle Name:DEE
Other - Last Name:WASHABAUGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3620 WILLOW BROOK DR
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:MO
Mailing Address - Zip Code:65109-9311
Mailing Address - Country:US
Mailing Address - Phone:573-219-1782
Mailing Address - Fax:
Practice Address - Street 1:1030 EDMONDS ST
Practice Address - Street 2:
Practice Address - City:JEFFERSON CITY
Practice Address - State:MO
Practice Address - Zip Code:65109-5213
Practice Address - Country:US
Practice Address - Phone:573-635-3381
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-27
Last Update Date:2016-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010023534225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist