MEDICARE: SHANNON ELIZABETH ROBERSON MOTR/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	1522	OK

Other Identifiers

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

General Provider Information

NPI Number	:	1851582803
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANNON ELIZABETH ROBERSON MOTR/L

Provider Business Mailing Address
First Line	:	14920 HERTZ QUAIL SPRINGS PKWY STE B
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73134-2637
Country	:	US
Telephone Number	:	405-607-4440
Fax Number	:	405-607-4495

Provider Business Practice Location Address
First Line	:	14920 HERTZ QUAIL SPRINGS PKWY STE B
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73134-2637
Country	:	US
Telephone Number	:	405-607-4440
Fax Number	:	405-607-4495

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

Provider Enumeration Date	:	08/06/2007
Last Update Date	:	08/25/2010

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