Provider Demographics
NPI:1023793056
Name:SHAFFER, AUSTIN (OTD, OTR/L)
Entity type:Individual
Prefix:DR
First Name:AUSTIN
Middle Name:
Last Name:SHAFFER
Suffix:
Gender:M
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3618 DOMINIC DR
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16506-6042
Mailing Address - Country:US
Mailing Address - Phone:814-881-8842
Mailing Address - Fax:
Practice Address - Street 1:2101 NAGLE RD
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16510-2189
Practice Address - Country:US
Practice Address - Phone:814-877-7078
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-19
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC019187225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist