Provider Demographics
NPI:1457655102
Name:LEWIS, SHANNON PLEASANTS (COTA/L)
Entity Type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:PLEASANTS
Last Name:LEWIS
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 SUMMERLYN PLACE
Mailing Address - Street 2:
Mailing Address - City:SEMORA
Mailing Address - State:NC
Mailing Address - Zip Code:27343
Mailing Address - Country:US
Mailing Address - Phone:336-234-7080
Mailing Address - Fax:
Practice Address - Street 1:901 RIDGE RD
Practice Address - Street 2:
Practice Address - City:ROXBORO
Practice Address - State:NC
Practice Address - Zip Code:27573-4511
Practice Address - Country:US
Practice Address - Phone:336-599-0106
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-10
Last Update Date:2011-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4120224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant