Individual
SHAWNA LEIGH FORTIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
1051 6TH ST, GREELEY, CO 80631-3278
(970) 353-0143
Mailing address
2411 49TH AVENUE CT, GREELEY, CO 80634-3705
(303) 659-7758
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OTA.0000146
CO
Other
Enumeration date
08/28/2018
Last updated
08/28/2018
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