Provider Demographics
NPI:1710878723
Name:CADDEL, SHEA (OTR)
Entity type:Individual
Prefix:
First Name:SHEA
Middle Name:
Last Name:CADDEL
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:89 CENTENNIAL LOOP STE A
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-7917
Mailing Address - Country:US
Mailing Address - Phone:951-310-8878
Mailing Address - Fax:
Practice Address - Street 1:89 CENTENNIAL LOOP STE A
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-7917
Practice Address - Country:US
Practice Address - Phone:541-342-1632
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-09
Last Update Date:2025-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR534036225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist