Provider Demographics
NPI:1487843074
Name:SHANNON, JULIA (OTR/L)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:
Last Name:SHANNON
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4730 SW MACADAM AVE STE 201I
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-6417
Mailing Address - Country:US
Mailing Address - Phone:503-707-6549
Mailing Address - Fax:
Practice Address - Street 1:4730 SW MACADAM AVE STE 201J
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-6417
Practice Address - Country:US
Practice Address - Phone:503-707-6549
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-18
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT00004540225X00000X
OR1074682225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist