Provider Demographics
NPI:1689706855
Name:SHEWMAKE, THOMAS HOWARD (OTR)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:HOWARD
Last Name:SHEWMAKE
Suffix:
Gender:M
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:PO BOX 836
Mailing Address - Street 2:
Mailing Address - City:CAMINO
Mailing Address - State:CA
Mailing Address - Zip Code:95709-0836
Mailing Address - Country:US
Mailing Address - Phone:530-391-0503
Mailing Address - Fax:
Practice Address - Street 1:3060 SNOWS RD
Practice Address - Street 2:
Practice Address - City:CAMINO
Practice Address - State:CA
Practice Address - Zip Code:95709-9578
Practice Address - Country:US
Practice Address - Phone:530-644-5915
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT 685225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist