Provider Demographics
NPI:1740638741
Name:SHIN, CARA (OTRL)
Entity type:Individual
Prefix:
First Name:CARA
Middle Name:
Last Name:SHIN
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1876 PLAZA DEL AMO
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90501-4543
Mailing Address - Country:US
Mailing Address - Phone:310-910-5678
Mailing Address - Fax:
Practice Address - Street 1:1876 PLAZA DEL AMO
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90501-4543
Practice Address - Country:US
Practice Address - Phone:310-910-5678
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-31
Last Update Date:2016-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16027225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist