Shanon M Funkhouser, COTA

Primary specialty

Occupational Therapy AssistantTaxonomy code 224Z00000X

License

810 Issued in OK

Practice address

9070 Harmony Dr Ste a
Midwest City, OK 73130-6257

Phone

(405) 455-5582

NPI assigned

Jun 5, 2007

Last updated

Jul 12, 2021By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1181001600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1626048000000",
    "number": "1053513606",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10700 S MAY AVE APT 126",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731702576",
            "telephone_number": "405-885-9141",
            "fax_number": "580-323-4509"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9070 HARMONY DR STE A",
            "city": "MIDWEST CITY",
            "state": "OK",
            "postal_code": "731306257",
            "telephone_number": "405-455-5582"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2316 W Modelle Ave",
            "address_purpose": "LOCATION",
            "city": "Clinton",
            "state": "OK",
            "postal_code": "736013722",
            "country_code": "US",
            "telephone_number": "580-323-4509",
            "fax_number": "580-323-4509",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FUNKHOUSER",
        "first_name": "SHANON",
        "middle_name": "M",
        "name_prefix": "Mrs.",
        "credential": "COTA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-06-05",
        "last_updated": "2021-07-12",
        "certification_date": "2021-07-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "224Z00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapy Assistant",
            "state": "OK",
            "license": "810",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Occupational Therapy Assistant in Midwest City, OK
• Providers in Midwest City, OK by specialty
• Occupational Therapy Assistant in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.