Provider Demographics
NPI:1770344731
Name:ACKERMAN, SHANNON CAROL (OTR/L)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:CAROL
Last Name:ACKERMAN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1510 S CONWELL AVE
Mailing Address - Street 2:
Mailing Address - City:WILLARD
Mailing Address - State:OH
Mailing Address - Zip Code:44890-9448
Mailing Address - Country:US
Mailing Address - Phone:419-964-5727
Mailing Address - Fax:
Practice Address - Street 1:1 FLASHES AVE
Practice Address - Street 2:
Practice Address - City:WILLARD
Practice Address - State:OH
Practice Address - Zip Code:44890-9394
Practice Address - Country:US
Practice Address - Phone:419-935-5341
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-17
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist