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NPI Code Detail

MEDICARE: SHAWN JEFFREY MACDONALD OT

MEDICARE: SHAWN JEFFREY MACDONALD OT
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
1106S00000XBehavior TechnicianRBT-22-214746MN
2225X00000XOccupational Therapist901261NE

General Provider Information

NPI Number : 1487207023
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHAWN JEFFREY MACDONALD OT
Provider Business Mailing Address
First Line : PO BOX 5285
Second Line :
City : GRAND ISLAND
State : NE
Zip : 68802-5285
Country : US
Telephone Number : 308-675-1853
Fax Number : 308-210-4121
Provider Business Practice Location Address
First Line : 819 TARA PLZ
Second Line :
City : PAPILLION
State : NE
Zip : 68046-2043
Country : US
Telephone Number : 907-206-4450
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/23/2019
Last Update Date : 06/02/2026

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