Provider Demographics
NPI:1992104517
Name:SHOOK, EMILY (COTA/L)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:SHOOK
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 1:8219 E US HIGHWAY 40
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE CITY
Mailing Address - State:IN
Mailing Address - Zip Code:47327-9621
Mailing Address - Country:US
Mailing Address - Phone:768-914-3834
Mailing Address - Fax:
Practice Address - Street 1:8219 E US HIGHWAY 40
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE CITY
Practice Address - State:IN
Practice Address - Zip Code:47327-9621
Practice Address - Country:US
Practice Address - Phone:765-914-3834
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-20
Last Update Date:2014-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN32002316A224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant