Individual
SHANNON ALEXANDRA STANLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MHSOT, OTR/L
Contact information
Practice address
341 WINN WAY, DECATUR, GA 30030-2120
(404) 341-4282
Mailing address
54 WALTHALL ST NE, ATLANTA, GA 30307-2623
(912) 293-5869
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT006272
GA
Other
Enumeration date
05/30/2018
Last updated
05/30/2018
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