Provider Demographics
NPI:1053927970
Name:CAIN, SHANNON (OTR/L)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:CAIN
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 1:209 SCOUT LN
Mailing Address - Street 2:
Mailing Address - City:CHINQUAPIN
Mailing Address - State:NC
Mailing Address - Zip Code:28521-8782
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:209 SCOUT LN
Practice Address - Street 2:
Practice Address - City:CHINQUAPIN
Practice Address - State:NC
Practice Address - Zip Code:28521-8782
Practice Address - Country:US
Practice Address - Phone:336-302-3774
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-16
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12734208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation