Individual
MR. SHANE DAVID FRASHER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
COTA
Contact information
Practice address
3540 S 43RD ST, MILWAUKEE, WI 53220-1502
(414) 328-2104
Mailing address
3540 S 43RD ST, MILWAUKEE, WI 53220-1502
(414) 328-2104
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
469-27
WI
Other
Enumeration date
09/27/2019
Last updated
09/27/2019
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