Provider Demographics
NPI:1407671498
Name:SHORE, CLAIRE ELAINE (COTA/L)
Entity type:Individual
Prefix:
First Name:CLAIRE
Middle Name:ELAINE
Last Name:SHORE
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 1:1245 SW 500TH RD
Mailing Address - Street 2:
Mailing Address - City:HOLDEN
Mailing Address - State:MO
Mailing Address - Zip Code:64040-9240
Mailing Address - Country:US
Mailing Address - Phone:816-682-1960
Mailing Address - Fax:
Practice Address - Street 1:201 S HOLDEN ST
Practice Address - Street 2:
Practice Address - City:WARRENSBURG
Practice Address - State:MO
Practice Address - Zip Code:64093-2306
Practice Address - Country:US
Practice Address - Phone:660-747-7823
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-15
Last Update Date:2024-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2024044293224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant