Provider Demographics
NPI:1255883088
Name:FORD, SHANNON (OT)
Entity type:Individual
Prefix:MS
First Name:SHANNON
Middle Name:
Last Name:FORD
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 N WELLS ST
Mailing Address - Street 2:500
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60610-7635
Mailing Address - Country:US
Mailing Address - Phone:312-401-0711
Mailing Address - Fax:
Practice Address - Street 1:1111 N WELLS ST
Practice Address - Street 2:500
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60610-7635
Practice Address - Country:US
Practice Address - Phone:312-401-0711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-27
Last Update Date:2016-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056.006297225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist