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Individual
SHANNON FAITH WICHMAN
Active
Individual
SHANNON FAITH WICHMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS OTR/L
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
018960
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
018960
NYS OT LICENSE
NY
Enumeration date
07/17/2014
Last updated
10/21/2020
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