Provider Demographics
NPI:1548927247
Name:SHADDY, SARAH WEI-JIANG (COTA/L)
Entity type:Individual
Prefix:MS
First Name:SARAH
Middle Name:WEI-JIANG
Last Name:SHADDY
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 1:2718 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804-1471
Mailing Address - Country:US
Mailing Address - Phone:417-438-1981
Mailing Address - Fax:
Practice Address - Street 1:128 SOUTHWINDS RD STE 7
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:AR
Practice Address - Zip Code:72730-8678
Practice Address - Country:US
Practice Address - Phone:479-267-2777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-17
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROT-A1762224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant