Provider Demographics
NPI:1669899639
Name:SHAFER, RICOLE (COTA/L)
Entity type:Individual
Prefix:
First Name:RICOLE
Middle Name:
Last Name:SHAFER
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 1:9720 N VIRGINIA AVE
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64155-2198
Mailing Address - Country:US
Mailing Address - Phone:816-506-1985
Mailing Address - Fax:816-346-1372
Practice Address - Street 1:2401 GILLHAM RD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64108-4619
Practice Address - Country:US
Practice Address - Phone:816-234-1659
Practice Address - Fax:816-346-1372
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-27
Last Update Date:2023-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2003020302282NC2000X, 224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
No282NC2000XHospitalsGeneral Acute Care HospitalChildren