Healthcare Provider Details

I. General information

NPI: 1710240494
Provider Name (Legal Business Name): SHAWN W MACKLIN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2012
Last Update Date: 06/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

731 S LANDRUM ST SPECIAL SERVICES -- CLAIM CARE
MOUNT VERNON MO
65712-1723
US

IV. Provider business mailing address

1662 N OAKFAIR PL
SPRINGFIELD MO
65802-7535
US

V. Phone/Fax

Practice location:
  • Phone: 417-466-7573
  • Fax:
Mailing address:
  • Phone: 417-461-5469
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number2000159256
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: