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NPI Code Detail

MEDICARE: GRACE SHAW OTR/L

MEDICARE: GRACE SHAW OTR/L
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
1225X00000XOccupational Therapist5920OK

General Provider Information

NPI Number : 1831911940
Entity Type Code : Individual
Provider Name (Legal Business Name) : GRACE SHAW OTR/L
Provider Business Mailing Address
First Line : 210 SHERLYN LN
Second Line :
City : SAPULPA
State : OK
Zip : 74066-8831
Country : US
Telephone Number : 918-906-9394
Fax Number :
Provider Business Practice Location Address
First Line : 2221 W DETROIT ST
Second Line :
City : BROKEN ARROW
State : OK
Zip : 74012-3628
Country : US
Telephone Number : 918-615-6492
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/29/2024
Last Update Date : 01/19/2026

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