Individual
JOSEPH RYAN SHANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1806 CARINO CT, PASO ROBLES, CA 93446-6375
(805) 674-6978
Mailing address
1806 CARINO CT, PASO ROBLES, CA 93446-6375
(805) 674-6978
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
OT-18394
CA
225X00000X
Occupational Therapist
Primary
OT-1974
ID
225X00000X
Occupational Therapist
OTP-OT-LIC-6130
MT
Other
Enumeration date
09/26/2018
Last updated
09/26/2018
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