Provider Demographics
NPI:1104431311
Name:BOND, SHAUNA LYNN (COTA)
Entity type:Individual
Prefix:MRS
First Name:SHAUNA
Middle Name:LYNN
Last Name:BOND
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4133 NE STALLINGS DR APT 304
Mailing Address - Street 2:
Mailing Address - City:NACOGDOCHES
Mailing Address - State:TX
Mailing Address - Zip Code:75965-1637
Mailing Address - Country:US
Mailing Address - Phone:936-645-4174
Mailing Address - Fax:
Practice Address - Street 1:4133 NE STALLINGS DR APT 304
Practice Address - Street 2:
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75965-1637
Practice Address - Country:US
Practice Address - Phone:936-645-4174
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-14
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX212061224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant