Candice Tyan Shaw, OT, BCBA

Primary specialty

Pediatric Occupational TherapistTaxonomy code 225XP0200X

License

993772

Practice address

1000 St. Louis Street
Suite 102
Fort Worth, TX 76104

Phone

(817) 921-5020

NPI assigned

Jul 25, 2012

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other names 1

• Candy Tyan Shaw Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1343174400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1394150400000",
    "number": "1811243074",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "305 NE LOOP 280",
            "address_2": "BUSINESS TOWER 1 SUITE 200",
            "city": "HURST",
            "state": "TX",
            "postal_code": "76053",
            "telephone_number": "817-292-8787",
            "fax_number": "817-789-6849"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 ST. LOUIS STREET",
            "address_2": "SUITE 102",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "76104",
            "telephone_number": "817-921-5020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAW",
        "first_name": "CANDICE",
        "middle_name": "TYAN",
        "credential": "OT, BCBA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-07-25",
        "last_updated": "2014-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": null,
            "license": "1-11-9504",
            "primary": false
        },
        {
            "code": "225XP0200X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Pediatrics",
            "state": null,
            "license": "993772",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CANDY",
            "last_name": "SHAW",
            "middle_name": "TYAN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Kavitha Shashikumar, M.D.
• David Nathan Shau, MD
• Elizabeth Shaver
• Kasey Shaw Salyer, LCSW
• Aaron Ivy Shaw, DO
• Carl R Shaw, MD
• Daphne Nizza Shaw, M.D.
• Jessica R Shaw, AGACNP-BC
• Kate M Shaw, LMSW
• Kelly L Shaw, RN

• Pediatric Occupational Therapist in Fort Worth, TX
• Providers in Fort Worth, TX by specialty
• Pediatric Occupational Therapist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.