Provider Demographics
NPI:1699548685
Name:SHANNON, KAREN MICHELLE
Entity type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:MICHELLE
Last Name:SHANNON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 MEADOW BEAUTY TER
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32771-6471
Mailing Address - Country:US
Mailing Address - Phone:865-591-5881
Mailing Address - Fax:
Practice Address - Street 1:245 BELLAGIO CIR
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32771-5001
Practice Address - Country:US
Practice Address - Phone:407-878-7664
Practice Address - Fax:407-878-7665
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-01
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL18168225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist