Provider Demographics
NPI:1144701483
Name:OSBORNE, SHONDA RAE (OTR/L)
Entity type:Individual
Prefix:
First Name:SHONDA
Middle Name:RAE
Last Name:OSBORNE
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 S COMMONWEALTH AVE
Mailing Address - Street 2:
Mailing Address - City:CORBIN
Mailing Address - State:KY
Mailing Address - Zip Code:40701-6408
Mailing Address - Country:US
Mailing Address - Phone:606-258-2525
Mailing Address - Fax:606-528-3916
Practice Address - Street 1:116 S COMMONWEALTH AVE
Practice Address - Street 2:
Practice Address - City:CORBIN
Practice Address - State:KY
Practice Address - Zip Code:40701-6408
Practice Address - Country:US
Practice Address - Phone:606-258-2525
Practice Address - Fax:606-528-3916
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-24
Last Update Date:2018-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY134406225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist