Individual
SHANNON WALL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
33 CANTERBERRY CIR, FLEMINGTON, NJ 08822-1861
(901) 596-2633
Mailing address
33 CANTERBERRY CIR, FLEMINGTON, NJ 08822-1861
(901) 596-2633
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
—
—
Other
Enumeration date
05/11/2015
Last updated
05/11/2015
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