Individual
SHANNON SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1065 E BROAD ST, MONTICELLO, MS 39654-7703
(601) 587-1211
Mailing address
125 T W BASS RD, CARSON, MS 39427-6276
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
TA2242
MS
Other
Enumeration date
11/17/2009
Last updated
11/17/2009
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