Individual
MRS. SHANNON LYNN GULLEDGE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
6733 N SPRING WAGON DR, TUCSON, AZ 85743-8669
(585) 331-0209
Mailing address
6733 N SPRING WAGON DR, TUCSON, AZ 85743-8669
(585) 331-0209
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
7311309
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6085
OCCUPATIONAL THERAPY ASSISTANT LICENSE
AZ
Enumeration date
11/16/2015
Last updated
11/16/2015
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