Provider Demographics
NPI:1760294763
Name:WEDDERBURN, SHAWN BUXTON
Entity type:Individual
Prefix:
First Name:SHAWN
Middle Name:BUXTON
Last Name:WEDDERBURN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 S UNION ST UNIT 303
Mailing Address - Street 2:
Mailing Address - City:PAWTUCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02860-3981
Mailing Address - Country:US
Mailing Address - Phone:347-327-0306
Mailing Address - Fax:
Practice Address - Street 1:500 WATERFRONT DR
Practice Address - Street 2:
Practice Address - City:EAST PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02914-5048
Practice Address - Country:US
Practice Address - Phone:401-272-5280
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-25
Last Update Date:2025-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIOT02283225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist