Provider Demographics
NPI:1154690261
Name:BELL, SHANNON CHRISTINE (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:CHRISTINE
Last Name:BELL
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 1:171 WANNER RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:NY
Mailing Address - Zip Code:13042-3244
Mailing Address - Country:US
Mailing Address - Phone:315-264-1530
Mailing Address - Fax:
Practice Address - Street 1:51 3RD ST
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:NY
Practice Address - Zip Code:13316-1114
Practice Address - Country:US
Practice Address - Phone:315-245-2500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-19
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010980-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist