Provider Demographics
NPI:1487962130
Name:SHANNON PATTON
Entity type:Organization
Organization Name:SHANNON PATTON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COTA
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:PATTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-427-7825
Mailing Address - Street 1:9993 FOX HALL CT
Mailing Address - Street 2:
Mailing Address - City:SAINT ANN
Mailing Address - State:MO
Mailing Address - Zip Code:63074-2003
Mailing Address - Country:US
Mailing Address - Phone:314-427-7825
Mailing Address - Fax:314-427-7825
Practice Address - Street 1:9993 FOX HALL CT
Practice Address - Street 2:
Practice Address - City:SAINT ANN
Practice Address - State:MO
Practice Address - Zip Code:63074-2003
Practice Address - Country:US
Practice Address - Phone:314-427-7825
Practice Address - Fax:314-427-7825
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-15
Last Update Date:2010-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006033512314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO224Z00000ZOtherOCCUPATIONAL THERAPY ASSISTANT