Provider Demographics
NPI:1720710379
Name:MULHOLLAN, SHANNON MARIE (MOT/OTR)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:MARIE
Last Name:MULHOLLAN
Suffix:
Gender:F
Credentials:MOT/OTR
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:MULHOLLAN
Other - Last Name:OCONNOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1301 BELLE PL
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76107-3360
Mailing Address - Country:US
Mailing Address - Phone:817-368-2629
Mailing Address - Fax:
Practice Address - Street 1:3141 DALHART DR
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76179-2663
Practice Address - Country:US
Practice Address - Phone:817-236-6116
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-30
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX109602225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist