MEDICARE: KATHERINE SHAFFER MS OTR/L

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	225XP0200X	Pediatric Occupational Therapist	OT004898	GA

General Provider Information

NPI Number	:	1609297514
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHERINE SHAFFER MS OTR/L

Provider Business Mailing Address
First Line	:	245 W HOWARD AVE
Second Line	:
City	:	DECATUR
State	:	GA
Zip	:	30030-3105
Country	:	US
Telephone Number	:	941-356-9510
Fax Number	:

Provider Business Practice Location Address
First Line	:	245 W HOWARD AVE
Second Line	:
City	:	DECATUR
State	:	GA
Zip	:	30030-3105
Country	:	US
Telephone Number	:	941-356-9510
Fax Number	:

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

Provider Enumeration Date	:	12/18/2013
Last Update Date	:	12/18/2013

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