Provider Demographics
NPI:1114020609
Name:SHOWAH, SHANNON (OT, PTA)
Entity Type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:
Last Name:SHOWAH
Suffix:
Gender:F
Credentials:OT, PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3410 COTILLION DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76017-3431
Mailing Address - Country:US
Mailing Address - Phone:817-729-3515
Mailing Address - Fax:
Practice Address - Street 1:3330 MATLOCK RD
Practice Address - Street 2:STE 206
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76015-2917
Practice Address - Country:US
Practice Address - Phone:214-339-4533
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-07
Last Update Date:2008-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX108946OtherLICENSE #
TX108946OtherLICENSE #