Provider Demographics
NPI:1629695705
Name:WOLLIN, SHANIA CAROL
Entity Type:Individual
Prefix:
First Name:SHANIA
Middle Name:CAROL
Last Name:WOLLIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:502 MAIN ST S
Mailing Address - Street 2:
Mailing Address - City:KARLSTAD
Mailing Address - State:MN
Mailing Address - Zip Code:56732-4008
Mailing Address - Country:US
Mailing Address - Phone:218-686-2032
Mailing Address - Fax:
Practice Address - Street 1:502 MAIN ST S
Practice Address - Street 2:
Practice Address - City:KARLSTAD
Practice Address - State:MN
Practice Address - Zip Code:56732-4008
Practice Address - Country:US
Practice Address - Phone:218-686-2032
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-06
Last Update Date:2020-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4676224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant