Provider Demographics
NPI:1508945924
Name:CONDON, SHANNON E (OTR)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:E
Last Name:CONDON
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:524 BARTON AVE
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60202-2711
Mailing Address - Country:US
Mailing Address - Phone:224-388-0778
Mailing Address - Fax:847-492-9310
Practice Address - Street 1:524 BARTON AVE
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60202-2711
Practice Address - Country:US
Practice Address - Phone:224-388-0778
Practice Address - Fax:847-492-9310
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics