Provider Demographics
NPI:1255611174
Name:FURR, SHANA KAYE
Entity type:Individual
Prefix:MRS
First Name:SHANA
Middle Name:KAYE
Last Name:FURR
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 1:15850 RANCHO VERDE CT
Mailing Address - Street 2:
Mailing Address - City:TRACY
Mailing Address - State:CA
Mailing Address - Zip Code:95304-9760
Mailing Address - Country:US
Mailing Address - Phone:209-836-1997
Mailing Address - Fax:
Practice Address - Street 1:2586 BUTHMANN AVE
Practice Address - Street 2:
Practice Address - City:TRACY
Practice Address - State:CA
Practice Address - Zip Code:95376-2165
Practice Address - Country:US
Practice Address - Phone:209-832-2273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-23
Last Update Date:2011-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9990225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation