Provider Demographics
NPI:1417763715
Name:HARRER, SHANNON (OTR)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:HARRER
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 1:2 HOLLYWOOD BLVD N STE 8
Mailing Address - Street 2:
Mailing Address - City:FORKED RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08731-4842
Mailing Address - Country:US
Mailing Address - Phone:609-200-1118
Mailing Address - Fax:
Practice Address - Street 1:2 HOLLYWOOD BLVD N STE 8
Practice Address - Street 2:
Practice Address - City:FORKED RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08731-4842
Practice Address - Country:US
Practice Address - Phone:609-200-1118
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-10
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00237400225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist