Provider Demographics
NPI:1669564522
Name:WARD, SHAWNDA
Entity type:Individual
Prefix:
First Name:SHAWNDA
Middle Name:
Last Name:WARD
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:HC 67 BOX 130
Mailing Address - Street 2:
Mailing Address - City:INDIANOLA
Mailing Address - State:OK
Mailing Address - Zip Code:74442
Mailing Address - Country:US
Mailing Address - Phone:918-424-1752
Mailing Address - Fax:
Practice Address - Street 1:221 E COMANCHE
Practice Address - Street 2:
Practice Address - City:MCALESTER
Practice Address - State:OK
Practice Address - Zip Code:74501
Practice Address - Country:US
Practice Address - Phone:918-423-1181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1182OtherLICENSE #