Provider Demographics
NPI:1235561085
Name:HUGENTOBER, SHANNON BROOKS (MS OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:BROOKS
Last Name:HUGENTOBER
Suffix:
Gender:F
Credentials:MS OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 GINGER ST
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22602-6903
Mailing Address - Country:US
Mailing Address - Phone:304-279-6615
Mailing Address - Fax:
Practice Address - Street 1:105 GINGER ST
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22602-6903
Practice Address - Country:US
Practice Address - Phone:304-279-6615
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-04
Last Update Date:2013-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA119004758225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist