Individual
MS. SHANNON GEISELL ISADORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
2545 24TH ST, ROCK ISLAND, IL 61201-5305
(309) 786-2527
Mailing address
1421 W SMITH ST, PEORIA, IL 61605-1948
(309) 472-4575
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
057002738
IL
Other
Enumeration date
09/11/2008
Last updated
08/12/2010
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