Basic Information
| Provider Information | |||||||||
| NPI: | 1396049995 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CAIN | ||||||||
| FirstName: | SHANNON | ||||||||
| MiddleName: | KATHLEEN | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MS, OTR/L | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | GORDER | ||||||||
| OtherFirstName: | SHANNON | ||||||||
| OtherMiddleName: | KATHLEEN | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | MS, OTR/L | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 2400 WILDWOOD RD | ||||||||
| Address2: | |||||||||
| City: | GIBSONIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 15044 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4124877771 | ||||||||
| FaxNumber: | 4124877772 | ||||||||
| Practice Location | |||||||||
| Address1: | 2400 WILDWOOD RD | ||||||||
| Address2: | |||||||||
| City: | GIBSONIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 15044 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4124877771 | ||||||||
| FaxNumber: | 4124877772 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/23/2010 | ||||||||
| LastUpdateDate: | 12/15/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | OC011420 | PA | Y | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
No ID Information.