Provider Demographics
NPI:1871193326
Name:WINN, SHANNON M (OTR/L)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:M
Last Name:WINN
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 1:529 STINE DR
Mailing Address - Street 2:
Mailing Address - City:CARLTON
Mailing Address - State:MN
Mailing Address - Zip Code:55718-9721
Mailing Address - Country:US
Mailing Address - Phone:218-485-1499
Mailing Address - Fax:
Practice Address - Street 1:529 STINE DR
Practice Address - Street 2:
Practice Address - City:CARLTON
Practice Address - State:MN
Practice Address - Zip Code:55718-9721
Practice Address - Country:US
Practice Address - Phone:218-485-1499
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-26
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN106346225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty