Provider Demographics
NPI:1386929495
Name:CAIN, SHIRLEY JANE (COTA/L)
Entity type:Individual
Prefix:MRS
First Name:SHIRLEY
Middle Name:JANE
Last Name:CAIN
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 1:5425 HIGH MILL AVE NW
Mailing Address - Street 2:
Mailing Address - City:MASSILLON
Mailing Address - State:OH
Mailing Address - Zip Code:44646-9005
Mailing Address - Country:US
Mailing Address - Phone:330-833-3174
Mailing Address - Fax:330-833-4216
Practice Address - Street 1:5425 HIGH MILL AVE NW
Practice Address - Street 2:
Practice Address - City:MASSILLON
Practice Address - State:OH
Practice Address - Zip Code:44646-9005
Practice Address - Country:US
Practice Address - Phone:330-833-3174
Practice Address - Fax:330-833-4216
Is Sole Proprietor?:No
Enumeration Date:2011-10-20
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOTA-O2618172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker