MEDICARE: SHAWN W MACKLIN

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	225X00000X	Occupational Therapist	2000159256	MO

General Provider Information

NPI Number	:	1710240494
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAWN W MACKLIN

Provider Business Mailing Address
First Line	:	1662 N OAKFAIR PL
Second Line	:
City	:	SPRINGFIELD
State	:	MO
Zip	:	65802-7535
Country	:	US
Telephone Number	:	417-461-5469
Fax Number	:

Provider Business Practice Location Address
First Line	:	731 S LANDRUM ST
Second Line	:	SPECIAL SERVICES -- CLAIM CARE
City	:	MOUNT VERNON
State	:	MO
Zip	:	65712-1723
Country	:	US
Telephone Number	:	417-466-7573
Fax Number	:

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

Provider Enumeration Date	:	06/19/2012
Last Update Date	:	06/19/2012

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