Healthcare Provider Details

I. General information

NPI: 1417089723
Provider Name (Legal Business Name): MONIKA SHUMBOPOISSANT OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MONIKA SHUMBO OTA

II. Dates (important events)

Enumeration Date: 03/12/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2224 AVE A PALM VIEW REHABILITATION & HEALTH CARE CENTER
YUMA AZ
85367
US

IV. Provider business mailing address

1763 S STREAM RD
BENNINGTON VT
05201-8710
US

V. Phone/Fax

Practice location:
  • Phone: 605-430-9361
  • Fax:
Mailing address:
  • Phone: 605-430-9361
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number205620
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number000330
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number002512
License Number StateCT
# 4
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number0720000441
License Number StateVT
# 5
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number636
License Number StateWY
# 6
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number941
License Number StateMT
# 7
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT00004270
License Number StateWA
# 8
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number3573
License Number StateAZ
# 9
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number09345
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: