Provider Demographics
NPI:1134990625
Name:BRAND, SHAWN R
Entity type:Individual
Prefix:
First Name:SHAWN
Middle Name:R
Last Name:BRAND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4586 S 116TH RD
Mailing Address - Street 2:
Mailing Address - City:BOLIVAR
Mailing Address - State:MO
Mailing Address - Zip Code:65613-8547
Mailing Address - Country:US
Mailing Address - Phone:417-326-2466
Mailing Address - Fax:417-326-7739
Practice Address - Street 1:4586 S 116TH RD
Practice Address - Street 2:
Practice Address - City:BOLIVAR
Practice Address - State:MO
Practice Address - Zip Code:65613-8547
Practice Address - Country:US
Practice Address - Phone:417-326-2466
Practice Address - Fax:417-326-7739
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-12
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO004689224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant