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General NPI Number Information
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NPI Number | 1063842300
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Entity Type | Individual
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Provider Name | SHANNON IRENE WEST MS, OTR/L
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Gender | Female
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Dates
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Enumeration Date | 11/23/2013
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Last Update Date | 11/23/2013
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Provider Practice Location Address
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Address Line | 460 N GARDEN PLZ
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City | POST FALLS
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State | ID
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Zip | 83854-6437
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Country | US
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Telephone | 208-777-0318
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Fax |
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Provider Business Mailing Address
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Address Line | 1059 N GOVERNMENT WAY
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City | COEUR D ALENE
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State | ID
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Zip | 83814-3140
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Country | US
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Telephone | 208-699-7091
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OT-954
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OT 60237619
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License Number State | WA
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