Jean R Shannon
Individual provider Active NPI Occupational Therapist · Bristol, WI
NPI 1508683103 · NPPES record last updated Sep 24, 2024
Key facts
- NPI
- 1508683103
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Occupational Therapist 225X00000X
- License
- 1849-19 (WI)
- Practice address
- 19010 93Rd St
Bristol, WI 53104-9611 - Phone
- (262) 891-3359
- NPI assigned
- Sep 24, 2024
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1849-19 | WI | MD | Occupational Therapist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 1849-19 | WI | Yes |
Addresses
Primary practice location
19010 93Rd St
Bristol, WI 53104-9611
Mailing address
19010 93Rd St
Bristol, WI 53104-9611
Phone (262) 891-3359
Other providers in Bristol, WI
- Whittney Koepnick
- Kristin M Keeler, S.C
- Megan May
- Erika McCullough
- Dennette L. Scheckel
- Town of Bristol
- United Hospital System
- Village of Bristol
- Nikki E Williams
All providers in Bristol, WI · Occupational Therapist in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 24, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.