Provider Demographics
NPI:1730842022
Name:STEFFEN, SHELBY SUE (COTA/L)
Entity type:Individual
Prefix:MRS
First Name:SHELBY
Middle Name:SUE
Last Name:STEFFEN
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:SHELBY
Other - Middle Name:SUE
Other - Last Name:BLUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA/L
Mailing Address - Street 1:4121 PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52002-2628
Mailing Address - Country:US
Mailing Address - Phone:563-583-4003
Mailing Address - Fax:
Practice Address - Street 1:4121 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52002-2628
Practice Address - Country:US
Practice Address - Phone:563-583-4003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-14
Last Update Date:2021-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA000902224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant