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Individual

SHANNON RENAE WAKEM

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
OTR, CHT

Contact information

Practice address
8995 SW MILEY RD STE 109, WILSONVILLE, OR 97070-5485
(503) 694-8366
(503) 694-8581
Mailing address
PO BOX 965, WILSONVILLE, OR 97070-0965
(503) 694-8366
(503) 694-8581

Taxonomy

Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
1049473
OR
225XH1200X
Hand Occupational Therapist
Primary
1049473
OR

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
297902
OR
Enumeration date
06/30/2008
Last updated
10/30/2021
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