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NPI Code Detail

MEDICARE: MS. SHANESE LYNETTE SHANKLIN MOT, OTR/L

MEDICARE: MS. SHANESE LYNETTE SHANKLIN MOT, OTR/L
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225X00000XOccupational TherapistOT-6233OH

General Provider Information

NPI Number : 1407037013
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. SHANESE LYNETTE SHANKLIN MOT, OTR/L
Provider Business Mailing Address
First Line : 2219 MAYFAIR RD
Second Line :
City : DAYTON
State : OH
Zip : 45405-3220
Country : US
Telephone Number : 937-275-0422
Fax Number :
Provider Business Practice Location Address
First Line : 5790 DENLINGER RD
Second Line :
City : DAYTON
State : OH
Zip : 45426-1838
Country : US
Telephone Number : 937-837-5581
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/26/2007
Last Update Date : 11/26/2007

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