MEDICARE: SHANNON LEIGH CHEATHAM

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	224Z00000X	Occupational Therapy Assistant	COTA-000026	AZ

General Provider Information

NPI Number	:	1861084261
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANNON LEIGH CHEATHAM

Provider Business Mailing Address
First Line	:	8951 W CLOUDWOOD DR
Second Line	:
City	:	MARANA
State	:	AZ
Zip	:	85653-8891
Country	:	US
Telephone Number	:	850-499-5098
Fax Number	:

Provider Business Practice Location Address
First Line	:	231 W GIACONDA WAY STE 103
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85704-4341
Country	:	US
Telephone Number	:	520-329-8830
Fax Number	:

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

Provider Enumeration Date	:	02/07/2021
Last Update Date	:	02/07/2021

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Directions to “ SHANNON LEIGH CHEATHAM ” Practice Location

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