Individual
SHANNON JOAN MILLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTA
Contact information
Practice address
84 NIGHTENGALE AVE, MASSENA, NY 13662-2538
(315) 764-3700
Mailing address
11 SISSON ST, POTSDAM, NY 13676-3597
(315) 244-3550
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
005863-1
NY
Other
Enumeration date
10/17/2011
Last updated
10/17/2011
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