Individual
MR. SHANNON CARL NELSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OTR
Contact information
Practice address
HIGHWAY 1 BOX 497, RED LAKE, MN 56671
(218) 679-3316
Mailing address
PO BOX 299, BAGLEY, MN 56621-0299
(218) 679-3316
(218) 679-3990
Taxonomy
Speciality
Code
Description
License number
State
282N00000X
General Acute Care Hospital
Primary
102239
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
102239
OCCUPATIONAL THERAPY LIC.
MN
Enumeration date
06/06/2007
Last updated
07/08/2007
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