Provider Demographics
NPI:1497248249
Name:OLIVERO-CHEW, SHANNON MARIAH (OT)
Entity Type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:MARIAH
Last Name:OLIVERO-CHEW
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 1:304 S. JONES BLVD
Mailing Address - Street 2:SUITE 3511
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89107
Mailing Address - Country:US
Mailing Address - Phone:575-479-7056
Mailing Address - Fax:
Practice Address - Street 1:304 S. JONES BLVD
Practice Address - Street 2:SUITE 3511
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89107
Practice Address - Country:US
Practice Address - Phone:575-479-7056
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-06
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16342225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist