Provider Demographics
NPI:1073678884
Name:LEWY, SHANNON (LOTR)
Entity type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:
Last Name:LEWY
Suffix:
Gender:F
Credentials:LOTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8448 SIEGEN LN
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70810-1938
Mailing Address - Country:US
Mailing Address - Phone:225-767-8182
Mailing Address - Fax:225-767-8757
Practice Address - Street 1:8448 SIEGEN LN
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70810-1938
Practice Address - Country:US
Practice Address - Phone:225-767-8182
Practice Address - Fax:225-767-8757
Is Sole Proprietor?:No
Enumeration Date:2006-12-22
Last Update Date:2010-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAZ11202225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA4B792C911Medicare ID - Type Unspecified