Provider Demographics
NPI:1194918029
Name:EVEN, SHAWN R (OTR/L)
Entity type:Individual
Prefix:MISS
First Name:SHAWN
Middle Name:R
Last Name:EVEN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 GREY OWL PASS
Mailing Address - Street 2:
Mailing Address - City:BROOKINGS
Mailing Address - State:SD
Mailing Address - Zip Code:57006-3656
Mailing Address - Country:US
Mailing Address - Phone:605-692-8525
Mailing Address - Fax:
Practice Address - Street 1:204 GREY OWL PASS
Practice Address - Street 2:
Practice Address - City:BROOKINGS
Practice Address - State:SD
Practice Address - Zip Code:57006-3656
Practice Address - Country:US
Practice Address - Phone:605-692-8525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-23
Last Update Date:2007-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0539225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist