Provider Demographics
NPI:1477501377
Name:SHAFFER, KATHLEEN DUKE (OTR-L)
Entity type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:DUKE
Last Name:SHAFFER
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 1:2415 W PECAN ST #100
Mailing Address - Street 2:
Mailing Address - City:PFLUGERVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78660-3670
Mailing Address - Country:US
Mailing Address - Phone:512-251-3230
Mailing Address - Fax:512-251-8760
Practice Address - Street 1:2415 W PECAN ST #100
Practice Address - Street 2:
Practice Address - City:PFLUGERVILLE
Practice Address - State:TX
Practice Address - Zip Code:78660-3670
Practice Address - Country:US
Practice Address - Phone:512-251-3230
Practice Address - Fax:512-251-8760
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX111233225XP0200X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX176646101Medicaid
TX8T6897OtherBCBS