Provider Demographics
NPI:1689092553
Name:SCHEIDT, SHANNON MARIA (COTA/L)
Entity Type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:MARIA
Last Name:SCHEIDT
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 1:4144 TOLBERT ROAD
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:OH
Mailing Address - Zip Code:45067
Mailing Address - Country:US
Mailing Address - Phone:513-668-6008
Mailing Address - Fax:513-726-0126
Practice Address - Street 1:5572 PRINCETON ROAD
Practice Address - Street 2:
Practice Address - City:LIBERTY TWP
Practice Address - State:OH
Practice Address - Zip Code:45011
Practice Address - Country:US
Practice Address - Phone:513-644-1193
Practice Address - Fax:513-644-1182
Is Sole Proprietor?:No
Enumeration Date:2014-03-28
Last Update Date:2014-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOTA01176224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant