Provider Demographics
NPI:1427296987
Name:PHELPS, SHANNA DANIELLE (MOTR/L)
Entity type:Individual
Prefix:MS
First Name:SHANNA
Middle Name:DANIELLE
Last Name:PHELPS
Suffix:
Gender:F
Credentials:MOTR/L
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Other - First Name:
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Mailing Address - Street 1:5334 OLYMPIC DR NW STE 101
Mailing Address - Street 2:
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98335-1722
Mailing Address - Country:US
Mailing Address - Phone:253-853-5155
Mailing Address - Fax:253-853-5150
Practice Address - Street 1:5334 OLYMPIC DR NW STE 101
Practice Address - Street 2:
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98335-1722
Practice Address - Country:US
Practice Address - Phone:253-853-5155
Practice Address - Fax:253-853-5150
Is Sole Proprietor?:No
Enumeration Date:2009-01-21
Last Update Date:2011-06-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OT60059342225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics