Active NPI
Shannon Sundholm
- Occupational Therapist
- West Branch, MI
National Provider Identifier
1669861191
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 5201007186
- Practice address
- 214 W Houghton Ave Ste 4
West Branch, MI 48661-1220 - Phone
- (989) 345-7151
- NPI assigned
- Jan 21, 2015
- Last updated
- Jan 21, 2015
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 5201007186 | MI | Primary |
Addresses
Primary practice location
214 W Houghton Ave Ste 4
West Branch, MI 48661-1220
Mailing address
2151 Neidhammer Dr
Bay City, MI 48706-9497
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5201007186 | MI | MD | Occupational Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Wright Rehabilitation Inc | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Specialist
- West Branch, MI
- NPI 1548599848
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1421798400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1421798400000",
"number": "1669861191",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2151 NEIDHAMMER DR",
"city": "BAY CITY",
"state": "MI",
"postal_code": "487069497"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "214 W HOUGHTON AVE STE 4",
"city": "WEST BRANCH",
"state": "MI",
"postal_code": "486611220",
"telephone_number": "989-345-7151"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SUNDHOLM",
"first_name": "SHANNON",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-01-21",
"last_updated": "2015-01-21",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "MI",
"license": "5201007186",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in West Branch, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 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.