Healthcare Provider Details

I. General information

NPI: 1194918029
Provider Name (Legal Business Name): SHAWN R. EVEN OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/23/2007
Last Update Date: 08/23/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 GREY OWL PASS
BROOKINGS SD
57006-3656
US

IV. Provider business mailing address

204 GREY OWL PASS
BROOKINGS SD
57006-3656
US

V. Phone/Fax

Practice location:
  • Phone: 605-692-8525
  • Fax:
Mailing address:
  • Phone: 605-692-8525
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number0539
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: