Healthcare Provider Details

I. General information

NPI: 1376086397
Provider Name (Legal Business Name): SHAUNA LYNN HENSON OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHAUNA LYNN SANTELER

II. Dates (important events)

Enumeration Date: 11/22/2016
Last Update Date: 11/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41 PARK CREEK DR
GREENVILLE SC
29605-4270
US

IV. Provider business mailing address

41 PARK CREEK DR
GREENVILLE SC
29605-4270
US

V. Phone/Fax

Practice location:
  • Phone: 864-299-1600
  • Fax:
Mailing address:
  • Phone: 864-299-1600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number4379
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number5320
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number12252
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: