Data from the NPPES registry. May not reflect recent changes — verify at nppes.cms.hhs.gov.
MR. SHANE BURGESS, COTA/L
Active Sole ProprietorSkilled Nursing Facility · PARIS, IL
Registration Details
- NPI Number
- 1932363736
- Provider Type
- Individual
- Gender
- Male
- NPI Issued
- Jul 11, 2008 (17.77834727906 yrs)
- Last Updated
- Jul 11, 2008
- License
-
057.002001 (IL)
- Sole Proprietor
- Yes
Practice Information
- Address
-
310 S EADS AVEPARIS, IL, 619441938Browse IL providers · Browse ZIP 61944
- Phone
- 2174655395
- Primary Specialty
-
Skilled Nursing Facility
314000000X
Data sourced from the NPPES National Provider Identifier registry. This information is for informational purposes only and is not a substitute for verifying credentials with the appropriate licensing authority. For official verification, use the NPPES NPI Registry or the relevant state medical board.