Provider Demographics
NPI:1902595457
Name:SHANAHAN, MIA SANCHEZ (OTR/L)
Entity Type:Individual
Prefix:
First Name:MIA
Middle Name:SANCHEZ
Last Name:SHANAHAN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:MIA
Other - Middle Name:SARAH
Other - Last Name:SANCHEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:200 HIGHLAND AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:NEEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02494-3035
Mailing Address - Country:US
Mailing Address - Phone:857-302-5715
Mailing Address - Fax:
Practice Address - Street 1:200 HIGHLAND AVE STE 202
Practice Address - Street 2:
Practice Address - City:NEEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02494-3035
Practice Address - Country:US
Practice Address - Phone:857-302-5715
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-02
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15933225X00000X
MA14488225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist