Provider Demographics
NPI:1487980181
Name:LUTTRELL, SHANI R (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:SHANI
Middle Name:R
Last Name:LUTTRELL
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6260 99TH ST
Mailing Address - Street 2:315
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-1842
Mailing Address - Country:US
Mailing Address - Phone:917-834-4061
Mailing Address - Fax:
Practice Address - Street 1:6260 99TH ST
Practice Address - Street 2:315
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-1842
Practice Address - Country:US
Practice Address - Phone:917-834-4061
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-30
Last Update Date:2009-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011227-1225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics