Provider Demographics
NPI:1275041576
Name:MAJOR, SHANNON E (OTR/L)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:E
Last Name:MAJOR
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 1:5100 YAUPON LN
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40213-3042
Mailing Address - Country:US
Mailing Address - Phone:502-533-2089
Mailing Address - Fax:
Practice Address - Street 1:5100 YAUPON LN
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40213-3042
Practice Address - Country:US
Practice Address - Phone:502-533-2089
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-21
Last Update Date:2018-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31006502A225X00000X
KY174611225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist