Provider Demographics
NPI:1356692727
Name:HELTON, SHANNON LEA (BHRS)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:LEA
Last Name:HELTON
Suffix:
Gender:F
Credentials:BHRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 NW 23RD ST
Mailing Address - Street 2:STE208
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73103-1469
Mailing Address - Country:US
Mailing Address - Phone:405-601-0423
Mailing Address - Fax:405-601-9626
Practice Address - Street 1:600 NW 23RD ST
Practice Address - Street 2:STE208
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73103-1469
Practice Address - Country:US
Practice Address - Phone:405-601-0423
Practice Address - Fax:405-601-9626
Is Sole Proprietor?:No
Enumeration Date:2012-09-26
Last Update Date:2012-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK0000225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner