Provider Demographics
NPI:1841550001
Name:WOLF, SHAWNA LAUREN (OT)
Entity type:Individual
Prefix:MS
First Name:SHAWNA
Middle Name:LAUREN
Last Name:WOLF
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2201 N CENTRAL EXPY
Mailing Address - Street 2:SUITE 110
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-2754
Mailing Address - Country:US
Mailing Address - Phone:214-265-1819
Mailing Address - Fax:
Practice Address - Street 1:2201 N CENTRAL EXPY
Practice Address - Street 2:SUITE 110
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-2754
Practice Address - Country:US
Practice Address - Phone:214-265-1819
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-22
Last Update Date:2012-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX305125225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics