Provider Demographics
NPI:1679949705
Name:SNYDER, SHIANTI MARIE (COTA/L)
Entity Type:Individual
Prefix:
First Name:SHIANTI
Middle Name:MARIE
Last Name:SNYDER
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:952 COUNTRY CLUB RD
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:VA
Mailing Address - Zip Code:24354-1508
Mailing Address - Country:US
Mailing Address - Phone:276-492-7755
Mailing Address - Fax:
Practice Address - Street 1:927 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:VA
Practice Address - Zip Code:24354-4117
Practice Address - Country:US
Practice Address - Phone:276-783-7529
Practice Address - Fax:276-783-7555
Is Sole Proprietor?:No
Enumeration Date:2015-08-12
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0131001455224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1760753545Medicaid