Provider Demographics
NPI:1598369217
Name:ARNOLD, SHANNON AVERY (OTR)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:AVERY
Last Name:ARNOLD
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:LEE
Other - Last Name:AVERY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11 WHITEWOOD LN
Mailing Address - Street 2:
Mailing Address - City:MERRIMACK
Mailing Address - State:NH
Mailing Address - Zip Code:03054-3934
Mailing Address - Country:US
Mailing Address - Phone:603-440-5429
Mailing Address - Fax:
Practice Address - Street 1:11 WHITEWOOD LN
Practice Address - Street 2:
Practice Address - City:MERRIMACK
Practice Address - State:NH
Practice Address - Zip Code:03054-3934
Practice Address - Country:US
Practice Address - Phone:603-440-5429
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-23
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23995225X00000X
MEOT3942225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEOT3942OtherOCCUPATIONAL THERAPY LICENSE