Provider Demographics
NPI:1063991974
Name:SHAMBURGER, SAWYER RAE (OTA)
Entity type:Individual
Prefix:MRS
First Name:SAWYER
Middle Name:RAE
Last Name:SHAMBURGER
Suffix:
Gender:F
Credentials:OTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3232 OLD HIGHWAY 70
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:OK
Mailing Address - Zip Code:73401
Mailing Address - Country:US
Mailing Address - Phone:903-388-6563
Mailing Address - Fax:
Practice Address - Street 1:208 NORTH PRAIRE ST
Practice Address - Street 2:
Practice Address - City:PILOT POINT
Practice Address - State:TX
Practice Address - Zip Code:73401
Practice Address - Country:US
Practice Address - Phone:940-324-6620
Practice Address - Fax:940-324-6624
Is Sole Proprietor?:No
Enumeration Date:2018-08-10
Last Update Date:2018-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX211887224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant