Individual
SHANNON RAE MATHERLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CRT
Contact information
Practice address
126 MISSOURI AVE, FORT LEONARD WOOD, MO 65473-8952
(573) 596-0131
(573) 596-0951
Mailing address
126 MISSOURI AVE, FORT LEONARD WOOD, MO 65473-8952
(573) 596-0131
(573) 596-0951
Taxonomy
Speciality
Code
Description
License number
State
227800000X
Certified Respiratory Therapist
Primary
2003003887
MO
Other
Enumeration date
09/01/2010
Last updated
09/01/2010
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