Provider Demographics
NPI:1205257151
Name:BRASWELL, SHAWNA C (COTA/L)
Entity type:Individual
Prefix:MRS
First Name:SHAWNA
Middle Name:C
Last Name:BRASWELL
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1725 SAVANNAH DR
Mailing Address - Street 2:
Mailing Address - City:ARTESIA
Mailing Address - State:NM
Mailing Address - Zip Code:88210-9622
Mailing Address - Country:US
Mailing Address - Phone:575-746-9648
Mailing Address - Fax:
Practice Address - Street 1:1725 SAVANNAH DR
Practice Address - Street 2:
Practice Address - City:ARTESIA
Practice Address - State:NM
Practice Address - Zip Code:88210-9622
Practice Address - Country:US
Practice Address - Phone:575-746-9648
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-19
Last Update Date:2013-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1020224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant