Provider Demographics
NPI:1578877452
Name:CALLIHAN, SHANNON LAREE (MA)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:LAREE
Last Name:CALLIHAN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2336-18 THORIUM DR
Mailing Address - Street 2:APT 18
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46143
Mailing Address - Country:US
Mailing Address - Phone:360-601-9363
Mailing Address - Fax:
Practice Address - Street 1:2336-18 THORIUM DR
Practice Address - Street 2:APT 18
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46143
Practice Address - Country:US
Practice Address - Phone:360-601-9363
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-03
Last Update Date:2010-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00020449225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist