Provider Demographics
NPI:1144824418
Name:VOELKER, SHANNA MARIE (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:SHANNA
Middle Name:MARIE
Last Name:VOELKER
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MISS
Other - First Name:SHANNA
Other - Middle Name:MARIE
Other - Last Name:CARTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:G4035 HOGARTH AVE
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-4933
Mailing Address - Country:US
Mailing Address - Phone:989-350-7746
Mailing Address - Fax:
Practice Address - Street 1:2280 TOWER HILL RD
Practice Address - Street 2:
Practice Address - City:HOUGHTON LAKE
Practice Address - State:MI
Practice Address - Zip Code:48629-8961
Practice Address - Country:US
Practice Address - Phone:989-422-5153
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-26
Last Update Date:2020-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT14962225X00000X
MI5201008097225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist