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General NPI Number Information
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NPI Number | 1174725733
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Entity Type | Individual
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Provider Name | SHAWN PETERS-BLASCYK
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Gender | Female
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Dates
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Enumeration Date | 06/04/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2160 ZINNIA LN
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City | LIBERAL
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State | KS
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Zip | 67901-2042
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Country | US
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Telephone | 615-896-6400
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Fax |
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Provider Business Mailing Address
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Address Line | 106 CAMBRIDGE CT
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City | GARDEN CITY
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State | KS
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Zip | 67846-9662
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Country | US
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Telephone | 620-260-9059
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 1702250
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License Number State | KS
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