Shanna Nicole Gwyn, COTA/L

Primary specialty

Occupational Therapy AssistantTaxonomy code 224Z00000X

License

11866 Issued in NC

Practice address

260 Village Lake Rd
Siler City, NC 27344-1820

Phone

(919) 742-4052

NPI assigned

Aug 2, 2018

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

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": "1533168000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1533168000000",
    "number": "1710465547",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "113A OLD SPRING RD",
            "city": "CHAPEL HILL",
            "state": "NC",
            "postal_code": "275168140",
            "telephone_number": "919-622-4286"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "260 VILLAGE LAKE RD",
            "city": "SILER CITY",
            "state": "NC",
            "postal_code": "273441820",
            "telephone_number": "919-742-4052"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "72 Chatham Business Dr",
            "address_purpose": "LOCATION",
            "city": "Pittsboro",
            "state": "NC",
            "postal_code": "273125687",
            "country_code": "US",
            "telephone_number": "919-542-6677",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GWYN",
        "first_name": "SHANNA",
        "middle_name": "NICOLE",
        "credential": "COTA/L",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-08-02",
        "last_updated": "2018-08-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "224Z00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapy Assistant",
            "state": "NC",
            "license": "11866",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NORTH CAROLINA BOARD OF  OCCUPATIONAL THERAPY",
            "identifier": "11866",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NATIONAL BOARD OF OCCUPATIONAL THERAPY",
            "identifier": "403214",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Tiesha Farmer Grant, LCSWA
• Frank Grasso, CRNA
• Gray Alternative Care
• Tara H Gregory, MPH,RD,LDN
• Margaret Farland Griffin, PA
• Ray Allen Hager Jr., O.D.
• James E Hall Jr., LCMHC LCAS CSI
• Savannah Harrison, PTA
• Rebecca Sue Hasmann, FNP
• Haynes Haven LLC

• Occupational Therapy Assistant in Siler City, NC
• Providers in Siler City, NC by specialty
• Occupational Therapy Assistant in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 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.

Verify at the official NPI Registry.