Shannon Victoria Modjeski, MOT, OTR/L

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

434200 Issued in OR

Practice address

13333 SW 68TH Pkwy
Tigard, OR 97223-9196

Phone

(503) 352-0240

NPI assigned

Feb 24, 2020

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

Other names 1

• Ms. Shannon Victoria Modjeski Professional name

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": "1582502400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1582502400000",
    "number": "1215561733",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2185 NE 106TH AVE APT 3411",
            "city": "HILLSBORO",
            "state": "OR",
            "postal_code": "971248291",
            "telephone_number": "971-533-4658"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13333 SW 68TH PKWY",
            "city": "TIGARD",
            "state": "OR",
            "postal_code": "972239196",
            "telephone_number": "503-352-0240"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MODJESKI",
        "first_name": "SHANNON",
        "middle_name": "VICTORIA",
        "credential": "MOT, OTR/L",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-02-24",
        "last_updated": "2020-02-24",
        "certification_date": "2020-02-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "OR",
            "license": "434200",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SHANNON",
            "last_name": "MODJESKI",
            "middle_name": "VICTORIA",
            "prefix": "MS.",
            "credential": "MOT, OTR/L",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Alonna Christine Mitsch
• Krislyn Miyagawa
• Emmanuel Mmasa
• Felagai Dustin Moananu
• Melissa Mocklin-Dwiggins, OTR/L
• Alaina Lotu Moeai
• Teresa Moen, RN
• Vishnu Mohan, M.D.
• Adam Garrett Mohr, D.C, DACBSP
• Keely Deering Mohr, M.S. SLP-CCC

• Occupational Therapist in Tigard, OR
• Providers in Tigard, OR by specialty
• Occupational Therapist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 24, 2020; 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.