Provider Demographics
NPI:1659733996
Name:CUTRO, SHANA (OTR)
Entity Type:Individual
Prefix:
First Name:SHANA
Middle Name:
Last Name:CUTRO
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 1:421 SE 10TH STREET
Mailing Address - Street 2:A102
Mailing Address - City:DANIA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33004
Mailing Address - Country:US
Mailing Address - Phone:561-676-0208
Mailing Address - Fax:
Practice Address - Street 1:6700 W COMMERCIAL BLVD
Practice Address - Street 2:
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33319-2115
Practice Address - Country:US
Practice Address - Phone:561-676-0208
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-25
Last Update Date:2018-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT17545225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist