Provider Demographics
NPI:1386140895
Name:SATTESON, SHAWNA DEBRA
Entity type:Individual
Prefix:MISS
First Name:SHAWNA
Middle Name:DEBRA
Last Name:SATTESON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:884 W RATTLER RD
Mailing Address - Street 2:
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:UT
Mailing Address - Zip Code:84045-3994
Mailing Address - Country:US
Mailing Address - Phone:801-885-8813
Mailing Address - Fax:
Practice Address - Street 1:884 W RATTLER RD
Practice Address - Street 2:
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:UT
Practice Address - Zip Code:84045-3994
Practice Address - Country:US
Practice Address - Phone:801-885-8813
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-03
Last Update Date:2018-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9066167-4202224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant