Healthcare Provider Details

I. General information

NPI: 1669307534
Provider Name (Legal Business Name): SHANNON MAASKE OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4502 N CENTRAL AVE
PHOENIX AZ
85012-1817
US

IV. Provider business mailing address

4813 W NORTH LN
GLENDALE AZ
85302-1822
US

V. Phone/Fax

Practice location:
  • Phone: 541-521-2187
  • Fax:
Mailing address:
  • Phone: 541-521-2187
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOTH-005076
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: