Provider Demographics
NPI:1285323428
Name:LIBKA, SHAUNA MARIE (COTA/L)
Entity type:Individual
Prefix:
First Name:SHAUNA
Middle Name:MARIE
Last Name:LIBKA
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4618 OLD SPARTANBURG RD APT H
Mailing Address - Street 2:
Mailing Address - City:TAYLORS
Mailing Address - State:SC
Mailing Address - Zip Code:29687-4252
Mailing Address - Country:US
Mailing Address - Phone:989-916-7146
Mailing Address - Fax:
Practice Address - Street 1:7 ROCKY MEADOW CT
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-3663
Practice Address - Country:US
Practice Address - Phone:864-275-1679
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-03
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4979225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics