Provider Demographics
NPI:1154996841
Name:SHEA, PATRICIA ANN (OTR/L)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:ANN
Last Name:SHEA
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:ANN
Other - Last Name:SHEA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OTR/L
Mailing Address - Street 1:23 AUGUSTUS CT UNIT 2008
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:MA
Mailing Address - Zip Code:01867-4075
Mailing Address - Country:US
Mailing Address - Phone:781-405-9060
Mailing Address - Fax:
Practice Address - Street 1:23 AUGUSTUS CT UNIT 2008
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:MA
Practice Address - Zip Code:01867-4075
Practice Address - Country:US
Practice Address - Phone:781-405-9060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-25
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA803225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA803OtherMA OT LICENSE