Provider Demographics
NPI:1679708986
Name:MADDEN, SHANNON MARIE (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:MARIE
Last Name:MADDEN
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 1:2799 W MAIN ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:WAPPINGERS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12590-1577
Mailing Address - Country:US
Mailing Address - Phone:845-297-9710
Mailing Address - Fax:845-297-9710
Practice Address - Street 1:2799 W MAIN ST
Practice Address - Street 2:SUITE B
Practice Address - City:WAPPINGERS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12590-1577
Practice Address - Country:US
Practice Address - Phone:845-297-9710
Practice Address - Fax:845-297-9710
Is Sole Proprietor?:No
Enumeration Date:2009-05-17
Last Update Date:2009-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006908225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist