MEDICARE: MRS. SHANNON PFAU OTR/L

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	105244	MN
2	225X00000X	Occupational Therapist	1850	ND

General Provider Information

NPI Number	:	1023553849
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SHANNON PFAU OTR/L

Provider Business Mailing Address
First Line	:	5532 59TH ST S
Second Line	:
City	:	FARGO
State	:	ND
Zip	:	58104-5688
Country	:	US
Telephone Number	:	612-987-6677
Fax Number	:

Provider Business Practice Location Address
First Line	:	4141 31ST AVE S STE 104
Second Line	:
City	:	FARGO
State	:	ND
Zip	:	58104-8778
Country	:	US
Telephone Number	:	701-353-1488
Fax Number	:	213-867-2798

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

Provider Enumeration Date	:	01/03/2017
Last Update Date	:	02/02/2026

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