Basic Information
| Provider Information | |||||||||
| NPI: | 1790281004 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HENSLEY | ||||||||
| FirstName: | SHANNON | ||||||||
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| Credential: | COTA/L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11912 DERBY AVE | ||||||||
| Address2: | |||||||||
| City: | GARFIELD HTS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441254334 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3303910362 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2801 E ROYALTON RD | ||||||||
| Address2: | |||||||||
| City: | BROADVIEW HTS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441472827 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4405264770 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/04/2018 | ||||||||
| LastUpdateDate: | 04/04/2018 | ||||||||
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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 | 224Z00000X | OTA007190 | OH | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant |
No ID Information.