Individual
SHANNON DOMFORT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
31840 US HIGHWAY 19 N, PALM HARBOR, FL 34684-3713
(727) 202-9200
Mailing address
31840 US HIGHWAY 19 N, PALM HARBOR, FL 34684-3713
(727) 202-9200
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
OT20621
FL
Other
Enumeration date
09/23/2015
Last updated
01/26/2020
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