Provider Demographics
NPI:1760723076
Name:KOKENNEN, SHAYNA JANELLE (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:SHAYNA
Middle Name:JANELLE
Last Name:KOKENNEN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 SHAWMUT AVE # 1
Mailing Address - Street 2:
Mailing Address - City:MARLBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01752-2909
Mailing Address - Country:US
Mailing Address - Phone:774-217-3936
Mailing Address - Fax:
Practice Address - Street 1:23 SHAWMUT AVE # 1
Practice Address - Street 2:
Practice Address - City:MARLBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01752-2909
Practice Address - Country:US
Practice Address - Phone:774-217-3936
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-12
Last Update Date:2013-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10834225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist