Provider Demographics
NPI:1043618200
Name:RITTENHOUSE, SHAUNA (OTR/L)
Entity Type:Individual
Prefix:
First Name:SHAUNA
Middle Name:
Last Name:RITTENHOUSE
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:634 N MAIN ST
Mailing Address - Street 2:STE 1
Mailing Address - City:O FALLON
Mailing Address - State:IL
Mailing Address - Zip Code:62269-3746
Mailing Address - Country:US
Mailing Address - Phone:618-690-0068
Mailing Address - Fax:888-452-2930
Practice Address - Street 1:634 N MAIN ST
Practice Address - Street 2:STE 1
Practice Address - City:O FALLON
Practice Address - State:IL
Practice Address - Zip Code:62269-3746
Practice Address - Country:US
Practice Address - Phone:618-690-0068
Practice Address - Fax:888-452-2930
Is Sole Proprietor?:No
Enumeration Date:2014-12-19
Last Update Date:2014-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056009782225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics