Provider Demographics
NPI:1568928380
Name:FUGATE, SHANNON ALYSE (OT)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:ALYSE
Last Name:FUGATE
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:A
Other - Last Name:CRUMPTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:7501 PROSPECT AVE
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64132-2103
Mailing Address - Country:US
Mailing Address - Phone:816-421-5848
Mailing Address - Fax:
Practice Address - Street 1:7501 PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64132-2103
Practice Address - Country:US
Practice Address - Phone:816-421-5848
Practice Address - Fax:816-237-2065
Is Sole Proprietor?:No
Enumeration Date:2019-02-17
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XL0004XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistLow Vision