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NPI Code Detail

MEDICARE: JESSICA A SHANNON OTR/L

MEDICARE: JESSICA A SHANNON 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
1225X00000XOccupational TherapistOC008257PA

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 : 1790912335
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSICA A SHANNON OTR/L
Provider Business Mailing Address
First Line : 317 EVERS AVE
Second Line :
City : SAINT MARYS
State : PA
Zip : 15857-1319
Country : US
Telephone Number : 814-389-2019
Fax Number :
Provider Business Practice Location Address
First Line : 100 HIGH POINT DR
Second Line :
City : KANE
State : PA
Zip : 16735-9704
Country : US
Telephone Number : 814-837-6706
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/22/2009
Last Update Date : 11/21/2017

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Directions to “ JESSICA A SHANNON OTR/L” Practice Location

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