Provider Demographics
NPI:1588961411
Name:SHANNON-WILSON, KAREN SUE (MSOTRL)
Entity type:Individual
Prefix:MS
First Name:KAREN
Middle Name:SUE
Last Name:SHANNON-WILSON
Suffix:
Gender:F
Credentials:MSOTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3837 HARSHBARGER RD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49203-3556
Mailing Address - Country:US
Mailing Address - Phone:517-581-0071
Mailing Address - Fax:
Practice Address - Street 1:35746 HARPER
Practice Address - Street 2:TOTA REHAB SERVICES, INC.
Practice Address - City:CLINTON TWP.
Practice Address - State:MI
Practice Address - Zip Code:48035
Practice Address - Country:US
Practice Address - Phone:586-791-9203
Practice Address - Fax:586-791-9204
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-11
Last Update Date:2011-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201003337251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health