Shanell L Black Southall, OT

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

3691 Issued in TN

Practice address

9303 Preston Run
Goodlettsville, TN 37072-1942

Phone

(615) 260-2978

NPI assigned

Sep 10, 2008

Last updated

Aug 4, 2021By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Rehabcare Group East, LLC

  dba RehabCare

  • Rehabilitation Clinic/Center
  • Chattanooga, TN
  • NPI 1063941508
  NPD (past)

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

{
    "created_epoch": "1221004800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1628035200000",
    "number": "1508015843",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9303 PRESTON RUN",
            "city": "GOODLETTSVILLE",
            "state": "TN",
            "postal_code": "370721942",
            "telephone_number": "615-260-2978"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9303 PRESTON RUN",
            "city": "GOODLETTSVILLE",
            "state": "TN",
            "postal_code": "370721942",
            "telephone_number": "615-260-2978"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "870 Oak Meadow Dr Ste 100",
            "address_purpose": "LOCATION",
            "city": "Franklin",
            "state": "TN",
            "postal_code": "370645607",
            "country_code": "US",
            "telephone_number": "800-603-6046",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BLACK SOUTHALL",
        "first_name": "SHANELL",
        "middle_name": "L",
        "credential": "OT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-09-10",
        "last_updated": "2021-08-04",
        "certification_date": "2021-08-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "TN",
            "license": "5565",
            "primary": false
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "TN",
            "license": "3691",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Occupational Therapist in Goodlettsville, TN
• Providers in Goodlettsville, TN by specialty
• Occupational Therapist in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 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.