Individual
SHANNON RENE PAINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LOTR
Contact information
Practice address
107 SUMMER LANE, WEST MONROE, LA 71921
(318) 396-1969
(318) 396-1969
Mailing address
PO BOX 1377, WEST MONROE, LA 71294
(318) 396-1969
(318) 396-1970
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
200124
LA
Other
Enumeration date
12/05/2006
Last updated
07/08/2007
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