Shannon R Manigault, COTA/L

Primary specialty

Occupational Therapy AssistantTaxonomy code 224Z00000X

License

6063 Issued in AZ

Practice address

400 W 5TH St
Yuma, AZ 85364-2945

Phone

(928) 502-7811

Fax

(928) 502-7818

NPI assigned

Jan 26, 2015

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

Other names 1

• Shannon R Dicken Former 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": "1422230400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1422230400000",
    "number": "1508256728",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 W 5TH ST",
            "city": "YUMA",
            "state": "AZ",
            "postal_code": "853642945",
            "telephone_number": "928-502-7811",
            "fax_number": "928-502-7818"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 W 5TH ST",
            "city": "YUMA",
            "state": "AZ",
            "postal_code": "853642945",
            "telephone_number": "928-502-7811",
            "fax_number": "928-502-7818"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANIGAULT",
        "first_name": "SHANNON",
        "middle_name": "R",
        "credential": "COTA/L",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-01-26",
        "last_updated": "2015-01-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "224Z00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapy Assistant",
            "state": "AZ",
            "license": "6063",
            "primary": true
        },
        {
            "code": "224Z00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapy Assistant",
            "state": "FL",
            "license": "OTA13855-18960",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SHANNON",
            "last_name": "DICKEN",
            "middle_name": "R",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Occupational Therapy Assistant in Yuma, AZ
• Providers in Yuma, AZ by specialty
• Occupational Therapy Assistant in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2015; 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.