Individual
SHANNA LEIGH DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
1004 HEALTH CENTER DR, MATTOON, IL 61938-9253
(217) 238-3435
Mailing address
2207 8TH STREET CIR, CHARLESTON, IL 61920-4066
(217) 549-3261
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
096002815
IL
Other
Enumeration date
07/20/2010
Last updated
12/12/2014
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