Provider Demographics
NPI:1386952570
Name:NIZNIK, SHANNON E (OT)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:E
Last Name:NIZNIK
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:E
Other - Last Name:PARKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2872 US HIGHWAY 34
Mailing Address - Street 2:
Mailing Address - City:OSWEGO
Mailing Address - State:IL
Mailing Address - Zip Code:60543-8346
Mailing Address - Country:US
Mailing Address - Phone:630-554-8890
Mailing Address - Fax:630-557-8803
Practice Address - Street 1:2872 US HIGHWAY 34
Practice Address - Street 2:
Practice Address - City:OSWEGO
Practice Address - State:IL
Practice Address - Zip Code:60543-8346
Practice Address - Country:US
Practice Address - Phone:630-554-8890
Practice Address - Fax:630-557-8803
Is Sole Proprietor?:No
Enumeration Date:2010-09-22
Last Update Date:2016-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056-008860225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist