Provider Demographics
NPI:1386745404
Name:LAWTON-SHIRLEY, NANCY KAY (OTR)
Entity type:Individual
Prefix:MS
First Name:NANCY
Middle Name:KAY
Last Name:LAWTON-SHIRLEY
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 1:237 COVE LN
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:WI
Mailing Address - Zip Code:54016-8030
Mailing Address - Country:US
Mailing Address - Phone:715-386-9572
Mailing Address - Fax:
Practice Address - Street 1:2705 ENLOE ST
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:WI
Practice Address - Zip Code:54016-8173
Practice Address - Country:US
Practice Address - Phone:715-386-2128
Practice Address - Fax:715-386-6119
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI652225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
641671046996OtherPREFERRED ONE
WI40607400Medicaid
15665OtherHEALTH PARTNERS
6407101OtherMEDICA
MN98G99LAOtherMN BCBS
7648022OtherAETNA