Provider Demographics
NPI:1639212012
Name:BETTINGER, SHAUNA THURSTON (OTR)
Entity Type:Individual
Prefix:MS
First Name:SHAUNA
Middle Name:THURSTON
Last Name:BETTINGER
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6924 MARLOWE LN
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29209-2320
Mailing Address - Country:US
Mailing Address - Phone:803-776-1883
Mailing Address - Fax:
Practice Address - Street 1:1901 BLANDING ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-3519
Practice Address - Country:US
Practice Address - Phone:803-253-6721
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2020-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2560225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist