Provider Demographics
NPI:1437283306
Name:HOUSTOUN, SHANNON D
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:D
Last Name:HOUSTOUN
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 1:1666 MONICA ST
Mailing Address - Street 2:
Mailing Address - City:DELTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32725-3968
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1666 MONICA ST
Practice Address - Street 2:
Practice Address - City:DELTONA
Practice Address - State:FL
Practice Address - Zip Code:32725-3968
Practice Address - Country:US
Practice Address - Phone:386-801-7095
Practice Address - Fax:386-532-1374
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT 8371225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU0593ZOtherMEDICARE
FLU0593ZOtherMEDICARE