Shannon Baldwin, COTA/L
Individual provider Active NPI Occupational Therapy Assistant · Vidor, TX
NPI 1992364129 · NPPES record last updated Jun 11, 2019
Key facts
- NPI
- 1992364129
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Occupational Therapy Assistant 224Z00000X
- License
- 213607 (TX)
- Practice address
- 470 Moore Dr
Vidor, TX 77662-3843 - Phone
- (409) 769-2454
- NPI assigned
- Jun 11, 2019
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 213607 | TX | MD | Occupational Therapy Assistant |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapy Assistant | 224Z00000X | 213607 | TX | Yes |
Addresses
Primary practice location
470 Moore Dr
Vidor, TX 77662-3843
Mailing address
470 Moore Dr
Vidor, TX 77662-3843
Phone (409) 769-2454
Other providers in Vidor, TX
- Archie Pharmacy LLC
- Charlene Ashworth
- Christyna Badeaux
- Karine A Bah
- Jessica Miller Baker
- Tiffany Larae Beggs
- Jenna Nicole Berg
- Kathy Blankenship
- Eugene V Boone
- Jean Louise Bourque
All providers in Vidor, TX · Occupational Therapy Assistant in Texas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 11, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.