Provider Demographics
NPI:1346314911
Name:DREYER, SHANNON LEA (OTR L)
Entity Type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:LEA
Last Name:DREYER
Suffix:
Gender:F
Credentials:OTR L
Other - Prefix:MISS
Other - First Name:SHANNON
Other - Middle Name:LEA
Other - Last Name:DREYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR L
Mailing Address - Street 1:326 COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:PERRYVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63775-2624
Mailing Address - Country:US
Mailing Address - Phone:573-547-7500
Mailing Address - Fax:573-547-6936
Practice Address - Street 1:326 COLLEGE ST
Practice Address - Street 2:
Practice Address - City:PERRYVILLE
Practice Address - State:MO
Practice Address - Zip Code:63775-2624
Practice Address - Country:US
Practice Address - Phone:573-547-7500
Practice Address - Fax:573-547-6936
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2003017427225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist