Provider Demographics
NPI:1700339769
Name:SHEARER, HOLLY (OTR/L)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:
Last Name:SHEARER
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 1:4619 SQUIRE CT NE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-2044
Mailing Address - Country:US
Mailing Address - Phone:413-505-7786
Mailing Address - Fax:
Practice Address - Street 1:1425 N KILLINGSWORTH ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97217-4541
Practice Address - Country:US
Practice Address - Phone:503-575-9402
Practice Address - Fax:888-769-4431
Is Sole Proprietor?:No
Enumeration Date:2016-07-26
Last Update Date:2018-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3488873225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR348873OtherOREGON STATE OCCUPATIONAL THERAPY LICENSURE