MEDICARE: SHANNON LOISEAU OTD

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
1	225XH1200X	Hand Occupational Therapist

General Provider Information

NPI Number	:	1730075177
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANNON LOISEAU OTD

Provider Business Mailing Address
First Line	:	693 HANON DR
Second Line	:
City	:	WILLISTON
State	:	VT
Zip	:	05495-8986
Country	:	US
Telephone Number	:	802-881-9726
Fax Number	:

Provider Business Practice Location Address
First Line	:	6355 WALKER LN STE 100
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22310-3238
Country	:	US
Telephone Number	:	703-797-6800
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/13/2025
Last Update Date	:	06/13/2025

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Directions to “ SHANNON LOISEAU OTD” Practice Location

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