Provider Demographics
NPI:1295573996
Name:MASTERS, SHANNON G (MS, OTR/L)
Entity type:Individual
Prefix:MS
First Name:SHANNON
Middle Name:G
Last Name:MASTERS
Suffix:
Gender:F
Credentials:MS, 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:PO BOX 1234
Mailing Address - Street 2:
Mailing Address - City:INWOOD
Mailing Address - State:WV
Mailing Address - Zip Code:25428-1234
Mailing Address - Country:US
Mailing Address - Phone:304-261-8173
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 1234
Practice Address - Street 2:
Practice Address - City:INWOOD
Practice Address - State:WV
Practice Address - Zip Code:25428-1234
Practice Address - Country:US
Practice Address - Phone:304-261-8173
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-17
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1317225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist