Provider Demographics
NPI:1477047611
Name:LAWSON, SHANNON RATH
Entity type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:RATH
Last Name:LAWSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14326 BOONDOCK LN
Mailing Address - Street 2:
Mailing Address - City:MONTPELIER
Mailing Address - State:VA
Mailing Address - Zip Code:23192-2522
Mailing Address - Country:US
Mailing Address - Phone:804-883-3003
Mailing Address - Fax:
Practice Address - Street 1:9130 STEPHENS MANOR DR
Practice Address - Street 2:
Practice Address - City:MECHANICSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23116-5165
Practice Address - Country:US
Practice Address - Phone:804-798-8043
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-20
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1036678224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant