Provider Demographics
NPI:1306115118
Name:SHEA, MARCIA N (OTD, OTR)
Entity type:Individual
Prefix:
First Name:MARCIA
Middle Name:N
Last Name:SHEA
Suffix:
Gender:F
Credentials:OTD, OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 BOXELDER LN
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14228-1351
Mailing Address - Country:US
Mailing Address - Phone:716-421-8375
Mailing Address - Fax:716-362-1553
Practice Address - Street 1:100 COLLEGE PKWY STE 100
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14221-6800
Practice Address - Country:US
Practice Address - Phone:716-871-9915
Practice Address - Fax:716-362-1553
Is Sole Proprietor?:No
Enumeration Date:2011-12-22
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN32001750A224Z00000X
IN31005997A225X00000X
NY027263-01225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant