Provider Demographics
NPI:1467676601
Name:ROCK, SHANNON COOPER (OT)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:COOPER
Last Name:ROCK
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8242 JEFFERS CIR
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-1924
Mailing Address - Country:US
Mailing Address - Phone:410-659-2933
Mailing Address - Fax:410-332-0619
Practice Address - Street 1:8242 JEFFERS CIR
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-1924
Practice Address - Country:US
Practice Address - Phone:410-659-2933
Practice Address - Fax:410-332-0619
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD03155282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital