Provider Demographics
NPI:1205155793
Name:TOURNIER, SHANNON KATHLEEN (COTA/L)
Entity type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:KATHLEEN
Last Name:TOURNIER
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:KATHLEEN
Other - Last Name:SQUIRES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA/L
Mailing Address - Street 1:14 RIVER REACH CT APT C
Mailing Address - Street 2:
Mailing Address - City:ALTON
Mailing Address - State:IL
Mailing Address - Zip Code:62002-7391
Mailing Address - Country:US
Mailing Address - Phone:314-910-2350
Mailing Address - Fax:
Practice Address - Street 1:14 RIVER REACH CT APT C
Practice Address - Street 2:
Practice Address - City:ALTON
Practice Address - State:IL
Practice Address - Zip Code:62002-7391
Practice Address - Country:US
Practice Address - Phone:314-910-2350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-23
Last Update Date:2010-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA 11278224Z00000X
IL057.002380224Z00000X
MO2003012800224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant