Provider Demographics
NPI:1881865202
Name:SHAW, KEVIN (OT)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:SHAW
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4207 S DALE MABRY HWY
Mailing Address - Street 2:#1109
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33611-1423
Mailing Address - Country:US
Mailing Address - Phone:727-776-4181
Mailing Address - Fax:
Practice Address - Street 1:3101 37TH AVE N
Practice Address - Street 2:SUITE A
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33713-1509
Practice Address - Country:US
Practice Address - Phone:727-328-0599
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-13
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT10326225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist