Individual
SHANNON WALTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR
Contact information
Practice address
8542 W GRAND RIVER AVE, BRIGHTON, MI 48116-2326
(734) 449-4649
(734) 449-4669
Mailing address
1311 MAMARONECK AVE STE 140, WHITE PLAINS, NY 10605-5224
(914) 294-4050
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
5201007411
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5201007411
STATE LICENSE
MI
Enumeration date
02/06/2007
Last updated
06/22/2023
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