Provider Demographics
NPI:1588996961
Name:ST. LOUIS, SHAD MICHAEL (MS, OTR, CDRS)
Entity type:Individual
Prefix:
First Name:SHAD
Middle Name:MICHAEL
Last Name:ST. LOUIS
Suffix:
Gender:M
Credentials:MS, OTR, CDRS
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Mailing Address - Street 1:1605 SAINT PAUL ST
Mailing Address - Street 2:#7
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80206-1618
Mailing Address - Country:US
Mailing Address - Phone:720-933-7228
Mailing Address - Fax:
Practice Address - Street 1:3425 S CLARKSON ST
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80113-2811
Practice Address - Country:US
Practice Address - Phone:303-789-8218
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-09
Last Update Date:2010-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1927224ZR0403X, 225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation
No224ZR0403XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantDriving and Community Mobility