1396049995 NPI number — SHANNON KATHLEEN CAIN MS, OTR/L

Table of content: SHANNON KATHLEEN CAIN MS, OTR/L (NPI 1396049995)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396049995 NPI number — SHANNON KATHLEEN CAIN MS, OTR/L

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CAIN
Provider First Name:
SHANNON
Provider Middle Name:
KATHLEEN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MS, OTR/L
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GORDER
Provider Other First Name:
SHANNON
Provider Other Middle Name:
KATHLEEN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MS, OTR/L
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1396049995
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/15/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2400 WILDWOOD RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GIBSONIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15044
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
412-487-7771
Provider Business Mailing Address Fax Number:
412-487-7772

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2400 WILDWOOD RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GIBSONIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15044
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
412-487-7771
Provider Business Practice Location Address Fax Number:
412-487-7772
Provider Enumeration Date:
12/23/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208100000X , with the licence number:  OC011420 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com