Active NPI
Michelle Shannon, OTR/L
- Occupational Therapist
- Omaha, NE
National Provider Identifier
1104124726
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 195
- Practice address
- 9220 Western Ave
Omaha, NE 68114-2297 - Phone
- (402) 393-7313
- NPI assigned
- Mar 6, 2011
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 195 | NE | Primary |
Addresses
Primary practice location
9220 Western Ave
Omaha, NE 68114-2297
Mailing address
1709 Kameo Dr
Omaha, NE 68122-5052
Phone (402) 290-4612
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 195 | NE | MD | Diagnostic Radiology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1299369600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1299369600000",
"number": "1104124726",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1709 KAMEO DR",
"city": "OMAHA",
"state": "NE",
"postal_code": "681225052",
"telephone_number": "402-290-4612"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9220 WESTERN AVE",
"city": "OMAHA",
"state": "NE",
"postal_code": "681142297",
"telephone_number": "402-393-7313"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHANNON",
"first_name": "MICHELLE",
"name_prefix": "Mrs.",
"credential": "OTR/L",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-03-06",
"last_updated": "2011-03-06",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "NE",
"license": "195",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Omaha, NE
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.