Provider Demographics
NPI:1801051065
Name:BENDER, SHAWN (COTA)
Entity type:Individual
Prefix:MR
First Name:SHAWN
Middle Name:
Last Name:BENDER
Suffix:
Gender:M
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:938 ABBEVILLE DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63130-2701
Mailing Address - Country:US
Mailing Address - Phone:314-616-4547
Mailing Address - Fax:314-991-2584
Practice Address - Street 1:938 ABBEVILLE DR
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63130-2701
Practice Address - Country:US
Practice Address - Phone:314-616-4547
Practice Address - Fax:314-991-2584
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-26
Last Update Date:2008-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO004473224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant