Basic Information
| Provider Information | |||||||||
| NPI: | 1821458035 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BRAWLEY | ||||||||
| FirstName: | SHANNON | ||||||||
| MiddleName: | |||||||||
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| Credential: | OT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 601 W 5TH AVE | ||||||||
| Address2: | SUITE 304 | ||||||||
| City: | SPOKANE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 992042705 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5096242353 | ||||||||
| FaxNumber: | 5096242501 | ||||||||
| Practice Location | |||||||||
| Address1: | 1000B N MILLER ST | ||||||||
| Address2: | |||||||||
| City: | WENATCHEE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 988011512 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5096638711 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/01/2016 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | OT60639357 | WA | Y | Other Service Providers | Specialist |
ID Information
| ID | Type | State | Issuer | Description | 1821458035 | 05 | WA | MEDICAID |