Individual
SHANNON KINGSTON DEMAGGIO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
1650 BARLOW ST, TRAVERSE CITY, MI 49686-4721
(248) 497-7896
Mailing address
3763 N SPIDER LAKE RD, TRAVERSE CITY, MI 49696-8442
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
5202007596
MI
Other
Enumeration date
04/15/2022
Last updated
04/15/2022
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