Active NPI
Shawna Deanne Iverson, MOT OTR L
- Occupational Therapist
- Salem, OR
National Provider Identifier
1922085307
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 1053130
- Practice address
- 290 Moyer LN NW
Salem, OR 97304 - Phone
- (503) 370-8990
- Fax
- (503) 363-4214
- NPI assigned
- Dec 28, 2005
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 1053130 | OR | Primary |
Addresses
Primary practice location
290 Moyer LN NW
Salem, OR 97304
Mailing address
1402 Gwinn St E
Monmouth, OR 97361
Phone (503) 510-5814
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 276082 | Medicaid | OR |
Other names 1
- Shawna Deanne Wallace
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1053130 | OR | MD | Occupational Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Easter Seals Oregon | Past | Accepting new patients | |
| Easter Seals Oregon Children'S Therapy Center | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Rehabilitation Clinic/Center
- Salem, OR
- NPI 1922072487
-
- Community/Behavioral Health Agency
- Salem, OR
- NPI 1720315120
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1135728000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1783900800000",
"number": "1922085307",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1402 GWINN ST E",
"city": "MONMOUTH",
"state": "OR",
"postal_code": "97361",
"telephone_number": "503-510-5814"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "290 MOYER LN NW",
"city": "SALEM",
"state": "OR",
"postal_code": "97304",
"telephone_number": "503-370-8990",
"fax_number": "503-363-4214"
}
],
"practiceLocations": [],
"basic": {
"last_name": "IVERSON",
"first_name": "SHAWNA",
"middle_name": "DEANNE",
"name_prefix": "Mrs.",
"credential": "MOT OTR L",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-12-28",
"last_updated": "2026-07-13",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "OR",
"license": "1053130",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "276082",
"state": "OR"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "SHAWNA",
"last_name": "WALLACE",
"middle_name": "DEANNE",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Salem, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.