Provider Demographics
NPI:1629230602
Name:HENRY, SHANNON JOANN (OTL)
Entity Type:Individual
Prefix:MS
First Name:SHANNON
Middle Name:JOANN
Last Name:HENRY
Suffix:
Gender:F
Credentials:OTL
Other - Prefix:MISS
Other - First Name:SHANNON
Other - Middle Name:JOANN
Other - Last Name:CURRIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:924 LAUREL ST
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97034-4955
Mailing Address - Country:US
Mailing Address - Phone:503-539-1034
Mailing Address - Fax:
Practice Address - Street 1:924 LAUREL ST
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97034-4955
Practice Address - Country:US
Practice Address - Phone:503-539-1034
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-30
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR462770225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics