Healthcare Provider Details

I. General information

NPI: 1861976425
Provider Name (Legal Business Name): SHANNON OBRIEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2018
Last Update Date: 09/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11877 E ARAPAHOE RD
CENTENNIAL CO
80112-3884
US

IV. Provider business mailing address

6350 S HAVANA ST APT 1314
ENGLEWOOD CO
80111-5661
US

V. Phone/Fax

Practice location:
  • Phone: 303-792-7368
  • Fax:
Mailing address:
  • Phone: 513-252-3456
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: