MEDICARE: NATASHA MARIE SHAFFER COTA/L OTA 007997

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	224Z00000X	Occupational Therapy Assistant	OTA007997	OH

General Provider Information

NPI Number	:	1053702738
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NATASHA MARIE SHAFFER COTA/L OTA 007997

Provider Business Mailing Address
First Line	:	8634 HEATHER LAKE DR. NW
Second Line	:
City	:	CANAL WINCHESTER
State	:	OH
Zip	:	43110
Country	:	US
Telephone Number	:	702-335-9249
Fax Number	:

Provider Business Practice Location Address
First Line	:	8634 HEATHER LAKE DR
Second Line	:
City	:	CANAL WINCHESTER
State	:	OH
Zip	:	43110-8249
Country	:	US
Telephone Number	:	702-335-9249
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/16/2015
Last Update Date	:	09/12/2024

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