Provider Demographics
NPI:1912272261
Name:RITTERBUSCH, SHANNON
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:RITTERBUSCH
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 1:100 LAUREL RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON TWP
Mailing Address - State:PA
Mailing Address - Zip Code:18436
Mailing Address - Country:US
Mailing Address - Phone:917-509-5348
Mailing Address - Fax:
Practice Address - Street 1:1252 RUNDLE
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18504
Practice Address - Country:US
Practice Address - Phone:917-509-5348
Practice Address - Fax:212-645-2939
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-20
Last Update Date:2014-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009758-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist