Provider Demographics
NPI:1427410224
Name:OSTMEIER, SHANNON ADOLPHINE ANN (LMT)
Entity Type:Individual
Prefix:MS
First Name:SHANNON
Middle Name:ADOLPHINE ANN
Last Name:OSTMEIER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 CORPORATE DR
Mailing Address - Street 2:SUITE 3
Mailing Address - City:HALFMOON
Mailing Address - State:NY
Mailing Address - Zip Code:12065-8636
Mailing Address - Country:US
Mailing Address - Phone:518-986-4123
Mailing Address - Fax:
Practice Address - Street 1:9 CORPORATE DR
Practice Address - Street 2:SUITE 3
Practice Address - City:HALFMOON
Practice Address - State:NY
Practice Address - Zip Code:12065-8636
Practice Address - Country:US
Practice Address - Phone:518-986-4123
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-22
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027864-1225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist