Active NPI
Shannon Marie Masterson, OTR/L
- Occupational Therapist
- Louisville, KY
National Provider Identifier
1568614014
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 131933
- Practice address
- 3504 Wexford Dr
Louisville, KY 40218-2143 - Phone
- (502) 386-1072
- Fax
- (502) 324-7830
- NPI assigned
- Oct 15, 2008
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | 131933 | KY | |
| Occupational Therapist | 225X00000X | 131933 | KY | Primary |
Addresses
Primary practice location
3504 Wexford Dr
Louisville, KY 40218-2143
Mailing address
3504 Wexford Dr
Louisville, KY 40218-2143
Phone (502) 386-1072
Other practice location 1
1900 Midland Trl
Ste 1 and 2
Shelbyville, KY 40065-8141
Phone (502) 633-1007
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 131933 | Other | KY | STATE LICENSE |
| 7100080320 | Medicaid | KY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in KY
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20090727000186 | KY | Practitioner - Occupational Therapist in Private Practice | 9638222516 | Practice locations: Louisville, KY |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 131933 | KY | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1224028800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1658361600000",
"number": "1568614014",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3504 WEXFORD DR",
"city": "LOUISVILLE",
"state": "KY",
"postal_code": "402182143",
"telephone_number": "502-386-1072",
"fax_number": "502-324-7830"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3504 WEXFORD DR",
"city": "LOUISVILLE",
"state": "KY",
"postal_code": "402182143",
"telephone_number": "502-386-1072",
"fax_number": "502-324-7830"
}
],
"practiceLocations": [
{
"address_1": "1900 Midland Trl",
"address_2": "Ste 1 and 2",
"address_purpose": "LOCATION",
"city": "Shelbyville",
"state": "KY",
"postal_code": "400658141",
"country_code": "US",
"telephone_number": "502-633-1007",
"fax_number": "502-437-0624",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "MASTERSON",
"first_name": "SHANNON",
"middle_name": "MARIE",
"name_prefix": "Ms.",
"credential": "OTR/L",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-10-15",
"last_updated": "2022-07-21",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "KY",
"license": "131933",
"primary": false
},
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "KY",
"license": "131933",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE LICENSE",
"identifier": "131933",
"state": "KY"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "7100080320",
"state": "KY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Louisville, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.