Provider Demographics
NPI:1245823525
Name:WROBEL, SHANNON (OTR)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:WROBEL
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2810 JACKSON AVE APT 32N
Mailing Address - Street 2:
Mailing Address - City:LONG ISLAND CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11101-3168
Mailing Address - Country:US
Mailing Address - Phone:516-384-4514
Mailing Address - Fax:
Practice Address - Street 1:2810 JACKSON AVE APT 32N
Practice Address - Street 2:
Practice Address - City:LONG ISLAND CITY
Practice Address - State:NY
Practice Address - Zip Code:11101-3168
Practice Address - Country:US
Practice Address - Phone:516-384-4514
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-17
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025292-01225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist