Provider Demographics
NPI:1285645408
Name:LOONEY-COLTON, SHANNON L (OT)
Entity type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:L
Last Name:LOONEY-COLTON
Suffix:
Gender:F
Credentials:OT
Other - Prefix:MS
Other - First Name:SHANNON
Other - Middle Name:L
Other - Last Name:MORROW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:1106 WALNUT ST
Mailing Address - Street 2:STE 110
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-2416
Mailing Address - Country:US
Mailing Address - Phone:805-788-0805
Mailing Address - Fax:805-788-0845
Practice Address - Street 1:4869 S BRADLEY RD
Practice Address - Street 2:STE 114
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93455-5065
Practice Address - Country:US
Practice Address - Phone:805-938-5320
Practice Address - Fax:805-938-5390
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2016-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO004326225X00000X
CAOT15494225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO218271833Medicare ID - Type Unspecified