Provider Demographics
NPI:1649407669
Name:HARPER, SHANLEY MARIE (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:SHANLEY
Middle Name:MARIE
Last Name:HARPER
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MISS
Other - First Name:SHANLEY
Other - Middle Name:MARIE
Other - Last Name:HARPER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:239 3RD AVE S
Mailing Address - Street 2:APT. F3
Mailing Address - City:SOUTH ST PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55075-2360
Mailing Address - Country:US
Mailing Address - Phone:608-217-5460
Mailing Address - Fax:
Practice Address - Street 1:5155 EAST RIVER ROAD
Practice Address - Street 2:SUITE 403
Practice Address - City:FRIDLEY
Practice Address - State:MN
Practice Address - Zip Code:55421
Practice Address - Country:US
Practice Address - Phone:763-572-2519
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-17
Last Update Date:2009-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4623-026225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist