Provider Demographics
NPI:1164149423
Name:WOODS, SHANNON DIANE (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:DIANE
Last Name:WOODS
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 1:67 W END DR
Mailing Address - Street 2:
Mailing Address - City:FAIRMONT
Mailing Address - State:WV
Mailing Address - Zip Code:26554-3549
Mailing Address - Country:US
Mailing Address - Phone:304-282-6149
Mailing Address - Fax:
Practice Address - Street 1:1 FREEDOMS WAY
Practice Address - Street 2:
Practice Address - City:CLARKSBURG
Practice Address - State:WV
Practice Address - Zip Code:26301-3564
Practice Address - Country:US
Practice Address - Phone:304-626-1602
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-26
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1897225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty