Healthcare Provider Details

I. General information

NPI: 1841742749
Provider Name (Legal Business Name): JESSICA ANN SHONEBARGER OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2016
Last Update Date: 12/03/2021
Certification Date: 12/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

380 ELM ST FL 2
LONDON OH
43140-9220
US

IV. Provider business mailing address

301 SCOTT FARMS BLVD
MARYSVILLE OH
43040-7009
US

V. Phone/Fax

Practice location:
  • Phone: 740-852-5700
  • Fax: 740-845-3282
Mailing address:
  • Phone: 734-489-5620
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT011163
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: