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General NPI Number Information
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NPI Number | 1467082560
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Entity Type | Individual
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Provider Name | SHAYNE N LEWIS MOT
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Gender | Female
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Dates
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Enumeration Date | 01/17/2020
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Last Update Date | 12/05/2025
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Provider Practice Location Address
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Address Line | 1140 COLLINSVILLE CROSSING BLVD
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City | COLLINSVILLE
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State | IL
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Zip | 62234-1880
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Country | US
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Telephone | 618-578-5901
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Fax |
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Provider Business Mailing Address
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Address Line | 600 OAKMONT LN STE 600C
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City | WESTMONT
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State | IL
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Zip | 60559-5581
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Country | US
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Telephone | 630-575-1980
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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 | 2020033416
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 056013632
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License Number State | IL
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