Provider Demographics
NPI:1720040181
Name:MERKLE, SHANNON (PHD, OTR/L, CHT)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:MERKLE
Suffix:
Gender:F
Credentials:PHD, OTR/L, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 GENERAL GREENE AVE, BLDG 42
Mailing Address - Street 2:MILITARY PERFORMANCE DIVISION, USARIEM
Mailing Address - City:NATICK
Mailing Address - State:MA
Mailing Address - Zip Code:01760
Mailing Address - Country:US
Mailing Address - Phone:508-206-2347
Mailing Address - Fax:
Practice Address - Street 1:10 GENERAL GREENE AVE, BLDG 42
Practice Address - Street 2:MILITARY PERFORMANCE DIVISION, USARIEM
Practice Address - City:NATICK
Practice Address - State:MA
Practice Address - Zip Code:01760
Practice Address - Country:US
Practice Address - Phone:508-206-2347
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2020-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01086225X00000X
1024550225X00000X
1071100331225XH1200X
SC3344225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand