Provider Demographics
NPI:1114961026
Name:SHAMASH, MICHELLE PERRY (OTRL CHT)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:PERRY
Last Name:SHAMASH
Suffix:
Gender:F
Credentials:OTRL CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 52ND ST STE 240
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53140-3423
Mailing Address - Country:US
Mailing Address - Phone:262-925-5000
Mailing Address - Fax:262-925-5001
Practice Address - Street 1:145 SAYTON RD STE F
Practice Address - Street 2:
Practice Address - City:FOX LAKE
Practice Address - State:IL
Practice Address - Zip Code:60020-1773
Practice Address - Country:US
Practice Address - Phone:847-629-5536
Practice Address - Fax:847-629-5163
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2018-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2251H1200X
IL056003039225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No2251H1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistHand