MEDICARE: SHANNON E NIZNIK OT

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	056-008860	IL

General Provider Information

NPI Number	:	1386952570
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANNON E NIZNIK OT

Provider Business Mailing Address
First Line	:	2872 US HIGHWAY 34
Second Line	:
City	:	OSWEGO
State	:	IL
Zip	:	60543-8346
Country	:	US
Telephone Number	:	630-554-8890
Fax Number	:	630-557-8803

Provider Business Practice Location Address
First Line	:	2872 US HIGHWAY 34
Second Line	:
City	:	OSWEGO
State	:	IL
Zip	:	60543-8346
Country	:	US
Telephone Number	:	630-554-8890
Fax Number	:	630-557-8803

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

Provider Enumeration Date	:	09/22/2010
Last Update Date	:	01/05/2016

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Directions to “ SHANNON E NIZNIK OT” Practice Location

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