Provider Demographics
NPI:1518182203
Name:JONES, SHANNON LEANN (OTR)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:LEANN
Last Name:JONES
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 1:116 MEADOW VIEW DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:OR
Mailing Address - Zip Code:97535-9431
Mailing Address - Country:US
Mailing Address - Phone:541-535-6070
Mailing Address - Fax:
Practice Address - Street 1:760 SPRING ST
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-6131
Practice Address - Country:US
Practice Address - Phone:541-890-7716
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2007-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT12181225X00000X
OR1020489225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist