Individual
MS. SHANNON WALL MANGUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR
Contact information
Practice address
1900 GRAVIER ST, NEW ORLEANS, LA 70112-2262
(504) 568-4302
(504) 568-4306
Mailing address
1900 GRAVIER ST, NEW ORLEANS, LA 70112-2262
(504) 568-4302
(504) 568-4306
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
LZ10405
LA
Other
Enumeration date
04/24/2015
Last updated
04/24/2015
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