Provider Demographics
NPI:1063842300
Name:WEST, SHANNON IRENE (MS, OTR/L)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:IRENE
Last Name:WEST
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1059 N GOVERNMENT WAY
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-3140
Mailing Address - Country:US
Mailing Address - Phone:208-699-7091
Mailing Address - Fax:
Practice Address - Street 1:460 N GARDEN PLZ
Practice Address - Street 2:
Practice Address - City:POST FALLS
Practice Address - State:ID
Practice Address - Zip Code:83854-6437
Practice Address - Country:US
Practice Address - Phone:208-777-0318
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-23
Last Update Date:2013-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDOT-954225X00000X
WAOT 60237619225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist