Healthcare Provider Details

I. General information

NPI: 1023359734
Provider Name (Legal Business Name): MS. DENISE LASHAUN SHAW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2013
Last Update Date: 03/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2828 NW 57TH ST STE 302
OKLAHOMA CITY OK
73112-7070
US

IV. Provider business mailing address

833 ENGLEWOOD RD
DEL CITY OK
73115-1333
US

V. Phone/Fax

Practice location:
  • Phone: 405-840-1253
  • Fax:
Mailing address:
  • Phone: 405-618-8420
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XM0800X
TaxonomyMental Health Occupational Therapist
License Number261QM0801X
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: