Disheaux, Shane Michael

Disheaux, Shane Michael is an individual health care provider with primary practice located at 2827 Northgate Blvd , Fort Wayne IN 46835-2903. He recently has only one registered license in Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Occupational Therapy Assistant, which is considered as his primary health care specialty. Disheaux, Shane Michael can be contacted via phone (260) 492-1498.

Contact Information

Primary practice address
2827 Northgate Blvd Fort Wayne IN 46835-2903
Phone: (260) 492-1498
Fax: (260) 492-1674
Website:
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Health care specialties

SpecialtyCodeLicense #State
Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Occupational Therapy Assistant 224Z00000X 32001345A Indiana

Profile Details

NPI number 1508063645
LBN Legal business name Disheaux, Shane Michael
Credentials Certified Occupational Therapy Assistant (COTA)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 2nd, 2007
Last updated Jul 8th, 2007 - about 19 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1508063645 NPPES
Indiana MEDICAID 1555-656

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