Active NPI
Shannon Whitacre
- Occupational Therapy Assistant
- Englewood, OH
National Provider Identifier
1720238280
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapy Assistant
- License
- 03900
- Practice address
- 425 Lauricella CT
Englewood, OH 45322 - Phone
- (937) 836-5143
- NPI assigned
- Sep 22, 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapy Assistant | 224Z00000X | 03900 | OH | Primary |
Addresses
Primary practice location
425 Lauricella CT
Englewood, OH 45322
Mailing address
11681 St RT 718
Laura, OH 45337
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 |
|---|---|---|---|
| 03900 | OH | MD | Occupational Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1222041600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1222041600000",
"number": "1720238280",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11681 ST RT 718",
"city": "LAURA",
"state": "OH",
"postal_code": "45337"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "425 LAURICELLA CT",
"city": "ENGLEWOOD",
"state": "OH",
"postal_code": "45322",
"telephone_number": "937-836-5143"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WHITACRE",
"first_name": "SHANNON",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-09-22",
"last_updated": "2008-09-22",
"status": "A"
},
"taxonomies": [
{
"code": "224Z00000X",
"taxonomy_group": "",
"desc": "Occupational Therapy Assistant",
"state": "OH",
"license": "03900",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Englewood, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.