CAUDILLO, SHANNON RENE' - Licensee Information

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Last Update: Saturday, December 21, 2024 3:49 AM CST
Next Update: Saturday, December 21, 2024 12:00 PM CST

CAUDILLO, SHANNON RENE'

This verification service provides current data extracted by the Oklahoma State Board of Medical Licensure and Supervision (OSBMLS) from its own database. The data enclosed in the green box below is provided by and controlled entirely by the OSBMLS and therefore constitutes a primary source verification of licensure status as authentic as a direct inquiry to the OSBMLS. NPI# and hospital privileges (if any) are provided by the licensee and not verified.

Practice Address:	PARC PLACE MEDICAL RESORT-POWERBACK REHAB 4200 EAST MEMORIAL RD OKLAHOMA CITY OK 73131 Address last updated on 10/6/2024
Phone #:	(405) 875-0040
Fax #:
County:	OKLAHOMA
License:	1198
Dated:	11/4/2010
Expires:	10/31/2025
License Type:	Occupational Therapy Assistant
Specialty:

Status:	Active
Status Class:	Fully Licensed
Restricted to:
CME Year:	2026

Pending and/or Past Disciplinary Actions: No Disciplinary Action Taken.

All information below is entered by the licensee but not verified by the Oklahoma Medical Board.

Locations:	Hours:	Languages:
PARC PLACE MEDICAL RESORT-POWERBACK REHAB 4200 EAST MEMORIAL RD OKLAHOMA CITY OK 73131 Phone #: (405) 875-0040 Fax #:

Name:	Type:	License Number:	Full/Part Time:
Primary Supervisor(s):
TIFFANY BROOKE ADAMS	OT	5321

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