Individual
SHANNON LANE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
410 10TH AVE W, PALMETTO, FL 34221-5032
(941) 722-3582
(941) 729-8322
Mailing address
410 10TH AVE W, PALMETTO, FL 34221-5032
(941) 722-3582
(941) 729-8322
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
2054
TN
224Z00000X
Occupational Therapy Assistant
OTA11297
FL
Other
Enumeration date
03/07/2012
Last updated
08/07/2014
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