Individual provider Active NPI

Shannon Boss, MSOT

  • Occupational Therapist
  • Grand Rapids, MI
National Provider Identifier
1063306538
Registry record updated May 23, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational TherapistTaxonomy code 225X00000X
License
OT24147 Issued in FL
Practice address
5429 Northland Dr NE Ste a
Grand Rapids, MI 49525-1089
Phone
(616) 855-0540
Fax
(616) 855-1185
NPI assigned
Jun 7, 2025
Last updated
May 23, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 23, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapist 225X00000X 5201014225 MI
Occupational Therapist 225X00000X OT24147 FL Primary

Addresses

Primary practice location

5429 Northland Dr NE Ste a
Grand Rapids, MI 49525-1089

Mailing address

5429 Northland Dr NE Ste a
Grand Rapids, MI 49525-1089
Phone (616) 855-0540

Other names 1

  • Shannon Flaherty Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250616003012 MI Practitioner - Occupational Therapist in Private Practice 3375054471 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Occupational Therapist in Private Practice
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

5429 Northland Dr NE
Suite a
Grand Rapids, MI 49525-1089
Phone (616) 855-0540

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
OT24147FLMDOccupational Therapist
5201014225MIMDOccupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Institute of Contextual Human Health, Wellness, and Performance Occupational Therapist CurrentSince Jun 10, 2025 Accepting new patients
Dynamic Movement and Recovery CurrentSince Jun 8, 2025 Accepting new patients

Locations

5429 Northland Dr NE
Ste A
Grand Rapids, MI 49525
Phone (616) 855-0540

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1749254400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1779494400000",
    "number": "1063306538",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5429 NORTHLAND DR NE STE A",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495251089",
            "telephone_number": "616-855-0540",
            "fax_number": "616-855-1185"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5429 NORTHLAND DR NE STE A",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495251089",
            "telephone_number": "616-855-0540",
            "fax_number": "616-855-1185"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOSS",
        "first_name": "SHANNON",
        "credential": "MSOT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-06-07",
        "last_updated": "2026-05-23",
        "certification_date": "2026-05-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "MI",
            "license": "5201014225",
            "primary": false
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "FL",
            "license": "OT24147",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SHANNON",
            "last_name": "FLAHERTY",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Grand Rapids, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 23, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.