Provider Demographics
NPI:1396299673
Name:ABERCROMBIE, SHANNON (COTA/L)
Entity type:Individual
Prefix:MS
First Name:SHANNON
Middle Name:
Last Name:ABERCROMBIE
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 TERRACE BLVD
Mailing Address - Street 2:
Mailing Address - City:LEWISTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17044-2423
Mailing Address - Country:US
Mailing Address - Phone:570-971-0080
Mailing Address - Fax:
Practice Address - Street 1:330 TERRACE BLVD
Practice Address - Street 2:
Practice Address - City:LEWISTOWN
Practice Address - State:PA
Practice Address - Zip Code:17044-2423
Practice Address - Country:US
Practice Address - Phone:570-971-0080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-04
Last Update Date:2016-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3811224Z00000X
PAOP007763224Z00000X
COOTA.0000765224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant