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NPI Code Detail

MEDICARE: MS. SHANNON PATRICIA GATEWOOD OTR

MEDICARE: MS. SHANNON PATRICIA GATEWOOD OTR
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 Therapist4682026WI

General Provider Information

NPI Number : 1891023511
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. SHANNON PATRICIA GATEWOOD OTR
Provider Business Mailing Address
First Line : 355 E MONTANA ST
Second Line :
City : MILWAUKEE
State : WI
Zip : 53207-2017
Country : US
Telephone Number : 414-744-0964
Fax Number :
Provider Business Practice Location Address
First Line : 2020 W WELLS ST
Second Line :
City : MILWAUKEE
State : WI
Zip : 53233-2720
Country : US
Telephone Number : 414-937-2049
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/19/2009
Last Update Date : 11/19/2009

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