Provider Demographics
NPI:1992931794
Name:THEIN, SHANON (OT)
Entity type:Individual
Prefix:MRS
First Name:SHANON
Middle Name:
Last Name:THEIN
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8016 PRINCETON DR
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34104-6666
Mailing Address - Country:US
Mailing Address - Phone:530-927-7022
Mailing Address - Fax:
Practice Address - Street 1:8016 PRINCETON DR
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34104-6666
Practice Address - Country:US
Practice Address - Phone:530-927-7022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-08
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA004925225X00000X
OT15965225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA004925OtherGEORGIA LICENSE