Individual
JESSICA A SHANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
100 HIGH POINT DR, KANE, PA 16735-9704
(814) 837-6706
Mailing address
317 EVERS AVE, SAINT MARYS, PA 15857-1319
(814) 389-2019
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OC008257
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1790912335
—
PA
Enumeration date
06/22/2009
Last updated
11/21/2017
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