IndividualActive
Shane Disheaux, COTA
NPI 1508063645 · Occupational Therapy Assistant · Fort Wayne, IN
Provider details
- NPI number
- 1508063645
- Entity type
- Individual
- Primary specialty
- Occupational Therapy AssistantRespiratory, Developmental, Rehabilitative and Restorative Service Providers
- Credential
- COTA
- Sex
- Male
- Sole proprietor
- No
- License
- 32001345A (IN)
Specialties & taxonomies
Respiratory, Developmental, Rehabilitative and Restorative Service Providers
Profile Score
Detailed profile(89/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
18 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
2827 Northgate Blvd
Fort Wayne, IN 46835-2903
Phone: (260) 492-1498
Fax: (260) 492-1674
Street-level locationGet directions
Mailing address
5305 Woodway Dr
Fort Wayne, IN 46835-3676
Registry dates
- Enumerated
- 2007-07-02
- Last updated
- 2007-07-08
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.