Provider Demographics
NPI:1740490812
Name:NATOLI, SHANNON ANN (MS,OT)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:ANN
Last Name:NATOLI
Suffix:
Gender:F
Credentials:MS,OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 AOLOA ST APT B125
Mailing Address - Street 2:
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-3010
Mailing Address - Country:US
Mailing Address - Phone:305-898-4774
Mailing Address - Fax:
Practice Address - Street 1:350 AOLOA ST APT B125
Practice Address - Street 2:
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-3010
Practice Address - Country:US
Practice Address - Phone:305-898-4774
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2015-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056007542225X00000X
FL9836225X00000X
HI1229225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist