Provider Demographics
NPI:1750672309
Name:CARMEN, SHANA (OT)
Entity Type:Individual
Prefix:
First Name:SHANA
Middle Name:
Last Name:CARMEN
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:681 DOWNING ST
Mailing Address - Street 2:
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-2220
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:92 WALRAVEN DR
Practice Address - Street 2:APARTMENT 2A
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-5118
Practice Address - Country:US
Practice Address - Phone:201-240-5274
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-29
Last Update Date:2018-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015084-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist