Provider Demographics
NPI:1841760923
Name:MILAZZO, SHANNON HEALY (MOTR/L)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:HEALY
Last Name:MILAZZO
Suffix:
Gender:F
Credentials:MOTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4240 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:MATTESON
Mailing Address - State:IL
Mailing Address - Zip Code:60443-2339
Mailing Address - Country:US
Mailing Address - Phone:708-921-5579
Mailing Address - Fax:
Practice Address - Street 1:3350 W SALT CREEK LN STE 115
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60005-1089
Practice Address - Country:US
Practice Address - Phone:847-757-2815
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-30
Last Update Date:2018-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056.012710225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist