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NPI Code Detail

MEDICARE: SHAWN PETERS-BLASCYK

MEDICARE: SHAWN PETERS-BLASCYK
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
1225X00000XOccupational Therapist1702250KS

General Provider Information

NPI Number : 1174725733
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHAWN PETERS-BLASCYK
Provider Business Mailing Address
First Line : 106 CAMBRIDGE CT
Second Line :
City : GARDEN CITY
State : KS
Zip : 67846-9662
Country : US
Telephone Number : 620-260-9059
Fax Number :
Provider Business Practice Location Address
First Line : 2160 ZINNIA LN
Second Line :
City : LIBERAL
State : KS
Zip : 67901-2042
Country : US
Telephone Number : 615-896-6400
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/04/2007
Last Update Date : 07/08/2007

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Directions to “ SHAWN PETERS-BLASCYK ” Practice Location

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