Provider Demographics
NPI:1780997775
Name:MCQUEENEY, SHAWN (OTR/L)
Entity type:Individual
Prefix:MR
First Name:SHAWN
Middle Name:
Last Name:MCQUEENEY
Suffix:
Gender:M
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 1:700 RAVINE DR
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13502-1130
Mailing Address - Country:US
Mailing Address - Phone:315-794-0341
Mailing Address - Fax:
Practice Address - Street 1:700 RAVINE DR
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13502-1130
Practice Address - Country:US
Practice Address - Phone:315-794-0341
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-19
Last Update Date:2010-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011168-1174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator