MEDICARE: SHAWNA MARIE LITTLE OTR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	OT17738	CA

General Provider Information

NPI Number	:	1023534955
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAWNA MARIE LITTLE OTR

Provider Business Mailing Address
First Line	:	1305 TINA CT
Second Line	:
City	:	MARTINEZ
State	:	CA
Zip	:	94553-4731
Country	:	US
Telephone Number	:	925-286-7383
Fax Number	:

Provider Business Practice Location Address
First Line	:	2770 PLEASANT HILL RD
Second Line	:
City	:	PLEASANT HILL
State	:	CA
Zip	:	94523-2044
Country	:	US
Telephone Number	:	925-935-1660
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/22/2017
Last Update Date	:	04/26/2021

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