Provider Demographics
NPI:1790812394
Name:SHAFFER, DAVID J (OTR)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:J
Last Name:SHAFFER
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 1:803 EAST HIGHWAY 72
Mailing Address - Street 2:
Mailing Address - City:FREDERICKTOWN
Mailing Address - State:MO
Mailing Address - Zip Code:63645-7292
Mailing Address - Country:US
Mailing Address - Phone:573-783-8001
Mailing Address - Fax:573-783-4045
Practice Address - Street 1:803 EAST HIGHWAY 72
Practice Address - Street 2:
Practice Address - City:FREDERICKTOWN
Practice Address - State:MO
Practice Address - Zip Code:63645-7292
Practice Address - Country:US
Practice Address - Phone:573-783-8001
Practice Address - Fax:573-783-4045
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO000546225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist