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NPI Code Detail

MEDICARE: SHANNON HESS

MEDICARE: SHANNON HESS
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
1225X00000XOccupational Therapist5201010120MI
2225X00000XOccupational TherapistOT3068ME
3225X00000XOccupational TherapistOC013343PA
4225X00000XOccupational Therapist9813NC
5225X00000XOccupational TherapistOT21227FL

General Provider Information

NPI Number : 1760805634
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHANNON HESS
Provider Business Mailing Address
First Line : 5535 S WILLIAMSON BLVD
Second Line : SUITE 774
City : PORT ORANGE
State : FL
Zip : 32128-8311
Country : US
Telephone Number : 800-330-7711
Fax Number : 386-944-7202
Provider Business Practice Location Address
First Line : 3250 WINKLER AVE
Second Line :
City : FORT MYERS
State : FL
Zip : 33916-9414
Country : US
Telephone Number : 239-939-4993
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/29/2014
Last Update Date : 11/23/2020

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