Provider Demographics
NPI:1811152820
Name:RIORDAN, SHANNON COYLE (OT)
Entity type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:COYLE
Last Name:RIORDAN
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:157 GRAND MAISON BLVD
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70471-8508
Mailing Address - Country:US
Mailing Address - Phone:985-626-7449
Mailing Address - Fax:985-626-7449
Practice Address - Street 1:157 GRAND MAISON BLVD
Practice Address - Street 2:
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70471-8508
Practice Address - Country:US
Practice Address - Phone:985-626-7449
Practice Address - Fax:985-626-7449
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-20
Last Update Date:2008-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAOTT.Z11085225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist