Provider Demographics
NPI:1245580380
Name:FENNER, SHANTE L
Entity Type:Individual
Prefix:MS
First Name:SHANTE
Middle Name:L
Last Name:FENNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11130 STRATFORD DR
Mailing Address - Street 2:#407
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-7242
Mailing Address - Country:US
Mailing Address - Phone:405-406-9649
Mailing Address - Fax:
Practice Address - Street 1:11130 STRATFORD DR
Practice Address - Street 2:#407
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-7242
Practice Address - Country:US
Practice Address - Phone:405-406-9649
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-17
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor