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NPI Code Detail

MEDICARE: SHANNON BREAKEY OTR/L

MEDICARE: SHANNON BREAKEY 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
1225XP0200XPediatric Occupational TherapistOT24764CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1134668510
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHANNON BREAKEY OTR/L
Provider Business Mailing Address
First Line : 10431 COMMERCE ST STE A
Second Line :
City : REDLANDS
State : CA
Zip : 92374-0110
Country : US
Telephone Number : 909-735-7654
Fax Number :
Provider Business Practice Location Address
First Line : 10431 COMMERCE ST STE A
Second Line :
City : REDLANDS
State : CA
Zip : 92374-0110
Country : US
Telephone Number : 909-735-7654
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/17/2017
Last Update Date : 07/26/2023

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Directions to “ SHANNON BREAKEY OTR/L” Practice Location

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