Provider Demographics
NPI:1447845912
Name:LAMLE, SHANNA (COTA/L)
Entity type:Individual
Prefix:
First Name:SHANNA
Middle Name:
Last Name:LAMLE
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 N HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73703-4519
Mailing Address - Country:US
Mailing Address - Phone:580-554-7065
Mailing Address - Fax:
Practice Address - Street 1:309 N HARRISON ST
Practice Address - Street 2:
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73703-4519
Practice Address - Country:US
Practice Address - Phone:580-554-7065
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-05
Last Update Date:2021-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2290225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist