Provider Demographics
NPI:1447721188
Name:FORRESTAL, SHANNON FAYE (OTR/L)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:FAYE
Last Name:FORRESTAL
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:FAYE
Other - Last Name:ARIANAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:4200 UNION CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21804-2377
Mailing Address - Country:US
Mailing Address - Phone:419-302-9598
Mailing Address - Fax:
Practice Address - Street 1:201 LONG AVE
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21804-5094
Practice Address - Country:US
Practice Address - Phone:410-677-5146
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-06
Last Update Date:2018-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD06602225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist