Individual
SHANNON HACKETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTRL
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
—
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1044152
P ONE
—
01
—
182G6HA
BCBS
—
01
—
6405829
MEDICA
—
01
—
670000341
METRAHEALTH MPIN
—
01
—
P00282811
RAILROAD MEDICARE
—
Enumeration date
07/18/2006
Last updated
02/14/2008
Update your record
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