Active NPI
Shannon Pettersson, OTR
- Occupational Therapist
- Pearland, TX
National Provider Identifier
1710463112
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 119267
- Practice address
- 9330 Broadway St Ste 312
Pearland, TX 77584-7895 - Phone
- (713) 383-9700
- Fax
- (713) 383-9795
- NPI assigned
- Jul 18, 2018
- Last updated
- Jul 18, 2018
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 119267 | TX | Primary |
Addresses
Primary practice location
9330 Broadway St Ste 312
Pearland, TX 77584-7895
Mailing address
9220 Kirby Dr Ste 1000
Houston, TX 77054-2534
Phone (713) 383-9700
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 |
|---|---|---|---|
| 119267 | TX | MD | Occupational Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| TCG Home Health LLC | 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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1531872000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1531872000000",
"number": "1710463112",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9220 KIRBY DR STE 1000",
"city": "HOUSTON",
"state": "TX",
"postal_code": "770542534",
"telephone_number": "713-383-9700",
"fax_number": "713-383-9795"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9330 BROADWAY ST STE 312",
"city": "PEARLAND",
"state": "TX",
"postal_code": "775847895",
"telephone_number": "713-383-9700",
"fax_number": "713-383-9795"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETTERSSON",
"first_name": "SHANNON",
"credential": "OTR",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2018-07-18",
"last_updated": "2018-07-18",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "TX",
"license": "119267",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pearland, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.