Provider Demographics
NPI:1184125890
Name:THOMSEN, SHANECE (OTR/L)
Entity type:Individual
Prefix:
First Name:SHANECE
Middle Name:
Last Name:THOMSEN
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 1:2402 E 5TH ST UNIT 1393
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85281-5147
Mailing Address - Country:US
Mailing Address - Phone:319-929-5904
Mailing Address - Fax:
Practice Address - Street 1:9821 E BELL RD
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-2344
Practice Address - Country:US
Practice Address - Phone:480-439-0099
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-27
Last Update Date:2018-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7396225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ7396OtherOCCUPATIONAL THERAPY BOARD OF EXAMINERS