Provider Demographics
NPI:1326560012
Name:CATES, SHIANNA NICOLE
Entity Type:Individual
Prefix:
First Name:SHIANNA
Middle Name:NICOLE
Last Name:CATES
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 1:152 CARDINAL DR
Mailing Address - Street 2:
Mailing Address - City:PANGBURN
Mailing Address - State:AR
Mailing Address - Zip Code:72121-9425
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:152 CARDINAL DR
Practice Address - Street 2:
Practice Address - City:PANGBURN
Practice Address - State:AR
Practice Address - Zip Code:72121-9425
Practice Address - Country:US
Practice Address - Phone:501-270-2562
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-13
Last Update Date:2017-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROT-A1233224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Single Specialty