Provider Demographics
NPI:1881070845
Name:SHINABERRY, RANDALL (MS OTRL)
Entity type:Individual
Prefix:MR
First Name:RANDALL
Middle Name:
Last Name:SHINABERRY
Suffix:
Gender:M
Credentials:MS OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2479 ROSEWOOD N
Mailing Address - Street 2:STE A
Mailing Address - City:MT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858-5004
Mailing Address - Country:US
Mailing Address - Phone:989-289-3755
Mailing Address - Fax:
Practice Address - Street 1:2479 ROSEWOOD N
Practice Address - Street 2:STE A
Practice Address - City:MT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-5004
Practice Address - Country:US
Practice Address - Phone:989-289-3755
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-31
Last Update Date:2015-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201009019225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist