Provider Demographics
NPI:1194801019
Name:CARRO, SHANNON A (OTR)
Entity type:Individual
Prefix:MS
First Name:SHANNON
Middle Name:A
Last Name:CARRO
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1655 S GEORGETOWN ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67218-4140
Mailing Address - Country:US
Mailing Address - Phone:316-685-0400
Mailing Address - Fax:316-612-0839
Practice Address - Street 1:340 S BROADWAY ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67202-4304
Practice Address - Country:US
Practice Address - Phone:316-267-5437
Practice Address - Fax:316-267-5444
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2015-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KST00720225000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter