Provider Demographics
NPI:1912082413
Name:LACANLALE, SHAUNA LOUISE (OTR/L)
Entity Type:Individual
Prefix:
First Name:SHAUNA
Middle Name:LOUISE
Last Name:LACANLALE
Suffix:
Gender:F
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 1:1400 E STIRRUP LN
Mailing Address - Street 2:
Mailing Address - City:QUEEN CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85243-3236
Mailing Address - Country:US
Mailing Address - Phone:480-472-3996
Mailing Address - Fax:480-472-3999
Practice Address - Street 1:1025 N. COUNTRY CLUB DR.
Practice Address - Street 2:MPS SPEC. ED.
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85201
Practice Address - Country:US
Practice Address - Phone:480-472-3996
Practice Address - Fax:480-472-3999
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3733225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist