Provider Demographics
NPI:1841742749
Name:SHONEBARGER, JESSICA ANN (OTR/L)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:ANN
Last Name:SHONEBARGER
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 1:301 SCOTT FARMS BLVD
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43040-7009
Mailing Address - Country:US
Mailing Address - Phone:734-489-5620
Mailing Address - Fax:
Practice Address - Street 1:380 ELM ST FL 2
Practice Address - Street 2:
Practice Address - City:LONDON
Practice Address - State:OH
Practice Address - Zip Code:43140-9220
Practice Address - Country:US
Practice Address - Phone:740-852-5700
Practice Address - Fax:740-845-3282
Is Sole Proprietor?:No
Enumeration Date:2016-10-27
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT011163225XP0200X, 225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics