Provider Demographics
NPI:1487946059
Name:RONVEAUX, SHANNON MAREE (MA, OTR/L)
Entity type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:MAREE
Last Name:RONVEAUX
Suffix:
Gender:F
Credentials:MA, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2820 CLARK AVE
Mailing Address - Street 2:
Mailing Address - City:NORCO
Mailing Address - State:CA
Mailing Address - Zip Code:92860-1903
Mailing Address - Country:US
Mailing Address - Phone:951-736-5090
Mailing Address - Fax:
Practice Address - Street 1:2820 CLARK AVE
Practice Address - Street 2:
Practice Address - City:NORCO
Practice Address - State:CA
Practice Address - Zip Code:92860-1903
Practice Address - Country:US
Practice Address - Phone:951-736-5090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-13
Last Update Date:2011-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11352225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist