Provider Demographics
NPI:1689241218
Name:DUBOIS, SHANNA (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:SHANNA
Middle Name:
Last Name:DUBOIS
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:216 FAIRGROUND ST
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37064-3531
Mailing Address - Country:US
Mailing Address - Phone:615-790-0154
Mailing Address - Fax:
Practice Address - Street 1:216 FAIRGROUND ST
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37064-3531
Practice Address - Country:US
Practice Address - Phone:615-790-0154
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-10
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2651225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist