Provider Demographics
NPI:1275182578
Name:BAITY, SHANNON MAE (OTR/L)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:MAE
Last Name:BAITY
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 1:528 S 188TH AVENUE CIR
Mailing Address - Street 2:
Mailing Address - City:ELKHORN
Mailing Address - State:NE
Mailing Address - Zip Code:68022-5642
Mailing Address - Country:US
Mailing Address - Phone:402-850-6272
Mailing Address - Fax:
Practice Address - Street 1:700 S HIGHWAY 6
Practice Address - Street 2:
Practice Address - City:GRETNA
Practice Address - State:NE
Practice Address - Zip Code:68028-7970
Practice Address - Country:US
Practice Address - Phone:402-332-3446
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-09
Last Update Date:2019-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1006225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist