Provider Demographics
NPI:1861829210
Name:STOOGENKE, SHAYNA (OTR/L)
Entity Type:Individual
Prefix:DR
First Name:SHAYNA
Middle Name:
Last Name:STOOGENKE
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 1:1200 1ST ST NE FL 9
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20002-7953
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1125 NEW JERSEY AVE NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20001-1365
Practice Address - Country:US
Practice Address - Phone:202-607-7607
Practice Address - Fax:202-654-6068
Is Sole Proprietor?:No
Enumeration Date:2013-10-01
Last Update Date:2013-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCOT010000865225X00000X
MD05648225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist