Provider Demographics
NPI:1194004234
Name:BABCOCK, SHANNON (OT)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:BABCOCK
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:CLAIRE
Other - Last Name:SINCLAIR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:189 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:BATH
Mailing Address - State:ME
Mailing Address - Zip Code:04530-2229
Mailing Address - Country:US
Mailing Address - Phone:207-689-4822
Mailing Address - Fax:
Practice Address - Street 1:189 NORTH ST
Practice Address - Street 2:
Practice Address - City:BATH
Practice Address - State:ME
Practice Address - Zip Code:04530-2229
Practice Address - Country:US
Practice Address - Phone:207-689-4822
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-08
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOT2284225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist