Provider Demographics
NPI:1619918653
Name:SHAFFER, CONSTANCE S (OTR L)
Entity Type:Individual
Prefix:
First Name:CONSTANCE
Middle Name:S
Last Name:SHAFFER
Suffix:
Gender:F
Credentials:OTR L
Other - Prefix:
Other - First Name:CONSTANCE
Other - Middle Name:M
Other - Last Name:SAATHOFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3915 GOLDEN VALLEY ROAD
Mailing Address - Street 2:COURAGE CENTER
Mailing Address - City:GOLDEN VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55422-4298
Mailing Address - Country:US
Mailing Address - Phone:763-520-0425
Mailing Address - Fax:763-520-0861
Practice Address - Street 1:3915 GOLDEN VALLEY ROAD
Practice Address - Street 2:COURAGE CENTER
Practice Address - City:GOLDEN VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55422-4298
Practice Address - Country:US
Practice Address - Phone:763-520-0425
Practice Address - Fax:763-520-0861
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2011-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN102152225X00000X, 225XR0403X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XR0403XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistDriving and Community Mobility
Provider Identifiers
StateIdentifier IDID TypeIssuer
6411150OtherMEDICA
76D35SHOtherBCBS MINNESOTA
HP11422OtherHEALTHPARTNERS