Basic Information
| Provider Information | |||||||||
| NPI: | 1033492806 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CARROLL | ||||||||
| FirstName: | SHANNON | ||||||||
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| Credential: | MSOTR/L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 AVERY RIDGE LN | ||||||||
| Address2: | |||||||||
| City: | HAMPTON FALLS | ||||||||
| State: | NH | ||||||||
| PostalCode: | 038442043 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 119 BELMONT ST | ||||||||
| Address2: | INPATIENT REHABILITATION | ||||||||
| City: | WORCESTER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 016052903 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5083341000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/27/2011 | ||||||||
| LastUpdateDate: | 09/27/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 10371 | MA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.