Provider Demographics
NPI:1659096824
Name:SHAW, MIA KATHERINE (OTD, OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:MIA
Middle Name:KATHERINE
Last Name:SHAW
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4904 SPRING RUN CT APT C
Mailing Address - Street 2:
Mailing Address - City:STOW
Mailing Address - State:OH
Mailing Address - Zip Code:44224-5335
Mailing Address - Country:US
Mailing Address - Phone:234-380-9414
Mailing Address - Fax:
Practice Address - Street 1:9410 CHILLICOTHE RD
Practice Address - Street 2:
Practice Address - City:KIRTLAND
Practice Address - State:OH
Practice Address - Zip Code:44094-9257
Practice Address - Country:US
Practice Address - Phone:234-380-9414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-10
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT12122225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist