Provider Demographics
NPI:1972744217
Name:SHAW, BARBARA JEAN (COTA)
Entity Type:Individual
Prefix:MRS
First Name:BARBARA
Middle Name:JEAN
Last Name:SHAW
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12215 SHADOE HOLLOW RD NE
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21502-8103
Mailing Address - Country:US
Mailing Address - Phone:301-777-8217
Mailing Address - Fax:301-777-8217
Practice Address - Street 1:12215 SHADOE HOLLOW RD NE
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-8103
Practice Address - Country:US
Practice Address - Phone:301-777-8217
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-17
Last Update Date:2009-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOP006574224Z00000X
MDA01678224Z00000X
WVC1669224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant