Healthcare Provider Details

I. General information

NPI: 1083586945
Provider Name (Legal Business Name): SHANNON HARWELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 N COLLINS BLVD
RICHARDSON TX
75080-3520
US

IV. Provider business mailing address

13635 SPRING GROVE AVE
DALLAS TX
75240-3726
US

V. Phone/Fax

Practice location:
  • Phone: 972-470-5855
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number125916
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: