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NPI Code Detail

MEDICARE: SHAD MICHAEL ST. LOUIS MS, OTR, CDRS

MEDICARE: SHAD MICHAEL ST. LOUIS MS, OTR, CDRS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1224ZR0403XDriving and Community Mobility Occupational Therapy Assistant1927CO
2225XP0019XPhysical Rehabilitation Occupational Therapist1927CO

General Provider Information

NPI Number : 1588996961
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHAD MICHAEL ST. LOUIS MS, OTR, CDRS
Provider Business Mailing Address
First Line : 1605 SAINT PAUL ST
Second Line : #7
City : DENVER
State : CO
Zip : 80206-1618
Country : US
Telephone Number : 720-933-7228
Fax Number :
Provider Business Practice Location Address
First Line : 3425 S CLARKSON ST
Second Line :
City : ENGLEWOOD
State : CO
Zip : 80113-2811
Country : US
Telephone Number : 303-789-8218
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/09/2010
Last Update Date : 02/09/2010

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