Healthcare Provider Details

I. General information

NPI: 1841960572
Provider Name (Legal Business Name): SHANNON JEAN MARTINEAU OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2021
Last Update Date: 03/26/2024
Certification Date: 03/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 S HWY 27
CLERMONT FL
34711-6816
US

IV. Provider business mailing address

2400 S HWY 27 UNIT B201
CLERMONT FL
34711-6816
US

V. Phone/Fax

Practice location:
  • Phone: 352-394-0212
  • Fax:
Mailing address:
  • Phone: 352-394-0212
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number22152
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: