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General NPI Number Information
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NPI Number | 1780735399
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Entity Type | Individual
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Provider Name | SHAUNA PEHLMAN NIENHAUS OTR
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Gender | Female
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Dates
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Enumeration Date | 01/12/2007
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 12997 NETTLES DR
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City | NEWPORT NEWS
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State | VA
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Zip | 23602-6913
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Country | US
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Telephone | 757-249-2699
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Fax |
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Provider Business Mailing Address
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Address Line | E9348 CHURCH RD
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City | NEW LONDON
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State | WI
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Zip | 54961-8414
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Country | US
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Telephone | 757-707-6944
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Fax | 253-904-8583
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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 | 0119007507
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License Number State | VA
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