Provider Demographics
NPI:1285793471
Name:RITTER VON TRAUTMANN, SHANNAN FRANCYNE (OTR)
Entity type:Individual
Prefix:MRS
First Name:SHANNAN
Middle Name:FRANCYNE
Last Name:RITTER VON TRAUTMANN
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:SHANNAN
Other - Middle Name:FRANCYNE
Other - Last Name:SCHEWE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:1083 BLAINE AVE
Mailing Address - Street 2:
Mailing Address - City:BLAINE
Mailing Address - State:WA
Mailing Address - Zip Code:98230-8021
Mailing Address - Country:US
Mailing Address - Phone:907-952-4442
Mailing Address - Fax:
Practice Address - Street 1:1083 BLAINE AVE
Practice Address - Street 2:
Practice Address - City:BLAINE
Practice Address - State:WA
Practice Address - Zip Code:98230-8021
Practice Address - Country:US
Practice Address - Phone:907-952-4442
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1530225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist