Provider Demographics
NPI:1164935128
Name:MCALLISTER, SHANNON RAY (OTR)
Entity Type:Individual
Prefix:MR
First Name:SHANNON
Middle Name:RAY
Last Name:MCALLISTER
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:633 FILLMORE AVE
Mailing Address - Street 2:
Mailing Address - City:DYER
Mailing Address - State:IN
Mailing Address - Zip Code:46311-1136
Mailing Address - Country:US
Mailing Address - Phone:219-616-0414
Mailing Address - Fax:
Practice Address - Street 1:7770 BURR ST
Practice Address - Street 2:
Practice Address - City:SCHERERVILLE
Practice Address - State:IN
Practice Address - Zip Code:46375-3400
Practice Address - Country:US
Practice Address - Phone:219-322-8855
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-13
Last Update Date:2017-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31005972A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist