Provider Demographics
NPI:1861689267
Name:SHAW, KARA (OTR/L)
Entity Type:Individual
Prefix:
First Name:KARA
Middle Name:
Last Name:SHAW
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:KARA
Other - Middle Name:
Other - Last Name:BRUNEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2807 SILVERTON DR
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:AR
Mailing Address - Zip Code:72019-8242
Mailing Address - Country:US
Mailing Address - Phone:501-765-7180
Mailing Address - Fax:
Practice Address - Street 1:2807 SILVERTON DR
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:AR
Practice Address - Zip Code:72019-8242
Practice Address - Country:US
Practice Address - Phone:501-765-7180
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-28
Last Update Date:2012-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROTR2131225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist