Provider Demographics
NPI:1912073115
Name:SHOUKAS, AMY E (OT)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:E
Last Name:SHOUKAS
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 W ELLSWORTH AVE
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80223-1624
Mailing Address - Country:US
Mailing Address - Phone:303-725-8785
Mailing Address - Fax:303-531-4908
Practice Address - Street 1:122 W ELLSWORTH AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80223-1624
Practice Address - Country:US
Practice Address - Phone:303-725-8785
Practice Address - Fax:303-531-4908
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2010-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO00001225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSUNIV OF KANSASOtherBACHELOR OF SCIENCE