Provider Demographics
NPI:1538777982
Name:SCHMITT, SHANNON MACKENZIE (OTD)
Entity type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:MACKENZIE
Last Name:SCHMITT
Suffix:
Gender:F
Credentials:OTD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 38779
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28278-1013
Mailing Address - Country:US
Mailing Address - Phone:704-577-4094
Mailing Address - Fax:704-583-2300
Practice Address - Street 1:2092 AYRSLEY TOWN BLVD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28273-4037
Practice Address - Country:US
Practice Address - Phone:704-577-4094
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-21
Last Update Date:2025-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC13366225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist