Provider Demographics
NPI:1295356194
Name:HILL, SHANNON MARTELL (OTR/L, OTD)
Entity Type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:MARTELL
Last Name:HILL
Suffix:
Gender:F
Credentials:OTR/L, OTD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1209 PRESSLEY DOWNS DR SE
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-7260
Mailing Address - Country:US
Mailing Address - Phone:336-307-6568
Mailing Address - Fax:
Practice Address - Street 1:1209 PRESSLEY DOWNS DR SE
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-7260
Practice Address - Country:US
Practice Address - Phone:336-307-6568
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-01
Last Update Date:2020-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC13189225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist