Provider Demographics
NPI:1689908618
Name:PODREBARAC, SHANNON (OT)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:PODREBARAC
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 1:2803 BUTTERFIELD ROAD
Mailing Address - Street 2:SUITE 350
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-1177
Mailing Address - Country:US
Mailing Address - Phone:630-572-6301
Mailing Address - Fax:630-572-6314
Practice Address - Street 1:2803 BUTTERFIELD ROAD
Practice Address - Street 2:SUITE 350
Practice Address - City:OAK BROOK
Practice Address - State:IL
Practice Address - Zip Code:60523-1177
Practice Address - Country:US
Practice Address - Phone:630-572-6301
Practice Address - Fax:630-572-6314
Is Sole Proprietor?:No
Enumeration Date:2009-09-23
Last Update Date:2009-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056-008280225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist