Individual
SHILOH DALLAS LEE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
651 S JACKSON ST, FRANKFORT, IN 46041-3029
(765) 242-2686
Mailing address
651 S JACKSON ST, FRANKFORT, IN 46041-3029
(765) 242-2686
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
32002624A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
32002624A
LICENSE NUMBER
IN
Enumeration date
09/19/2019
Last updated
09/19/2019
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