Provider Demographics
NPI:1063088334
Name:BROWN, SHANNON (OTR/L)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 FIDDLERS RUN BLVD
Mailing Address - Street 2:
Mailing Address - City:MORGANTON
Mailing Address - State:NC
Mailing Address - Zip Code:28655-0095
Mailing Address - Country:US
Mailing Address - Phone:828-430-3558
Mailing Address - Fax:828-430-3522
Practice Address - Street 1:121 FIDDLERS RUN BLVD
Practice Address - Street 2:
Practice Address - City:MORGANTON
Practice Address - State:NC
Practice Address - Zip Code:28655-0095
Practice Address - Country:US
Practice Address - Phone:828-430-3558
Practice Address - Fax:828-430-3522
Is Sole Proprietor?:No
Enumeration Date:2021-05-27
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC13629225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist