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General NPI Number Information
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NPI Number | 1558975854
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Entity Type | Individual
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Provider Name | SHAY LYNN RAE TASKER OTR/L
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Gender | Female
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Dates
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Enumeration Date | 09/03/2020
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Last Update Date | 09/03/2020
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Provider Practice Location Address
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Address Line | 4767 FRANKFORT HWY
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City | RIDGELEY
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State | WV
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Zip | 26753-7772
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Country | US
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Telephone | 304-738-4045
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Fax |
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Provider Business Mailing Address
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Address Line | 2177 SWANTON RD
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City | SWANTON
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State | MD
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Zip | 21561-1009
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Country | US
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Telephone | 301-616-2327
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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 | 09107
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License Number State | MD
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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 | 2123
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License Number State | WV
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