Provider Demographics
NPI:1306479076
Name:SHIELDS, KARI LEAH (OTR)
Entity type:Individual
Prefix:
First Name:KARI
Middle Name:LEAH
Last Name:SHIELDS
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:980 NW COUNTY ROAD 3331
Mailing Address - Street 2:
Mailing Address - City:FROST
Mailing Address - State:TX
Mailing Address - Zip Code:76641-3454
Mailing Address - Country:US
Mailing Address - Phone:712-790-9807
Mailing Address - Fax:
Practice Address - Street 1:300 W HWY 6
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76712
Practice Address - Country:US
Practice Address - Phone:254-761-8500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-20
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX113319225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist