Provider Demographics
NPI:1790140622
Name:SHOEMAKER, KATIE COBB (COTA/L)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:COBB
Last Name:SHOEMAKER
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7980 CHAPEL HILL RD
Mailing Address - Street 2:#115
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27513-4648
Mailing Address - Country:US
Mailing Address - Phone:919-535-3930
Mailing Address - Fax:
Practice Address - Street 1:7980 CHAPEL HILL RD
Practice Address - Street 2:#115
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27513-4648
Practice Address - Country:US
Practice Address - Phone:919-535-3930
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-18
Last Update Date:2015-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9904224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant