Provider Demographics
NPI:1861828881
Name:BURKE, SHANA MARIE (MOTR/L)
Entity type:Individual
Prefix:
First Name:SHANA
Middle Name:MARIE
Last Name:BURKE
Suffix:
Gender:F
Credentials:MOTR/L
Other - Prefix:
Other - First Name:SHANA
Other - Middle Name:MARIE
Other - Last Name:SCHILOUSKY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MOTR/L
Mailing Address - Street 1:1820 HILLCREST DR STE A
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:NE
Mailing Address - Zip Code:68005-3636
Mailing Address - Country:US
Mailing Address - Phone:402-660-2926
Mailing Address - Fax:
Practice Address - Street 1:1820 HILLCREST DR STE A
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:NE
Practice Address - Zip Code:68005-3636
Practice Address - Country:US
Practice Address - Phone:402-660-2926
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-23
Last Update Date:2014-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA002397225X00000X
NE1733225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist