Individual
SHANNON MORTIMER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LAT, C
Contact information
Practice address
9634 W ROSEDALE AVE, WEST ALLIS, WI 53227-3332
(920) 418-0460
Mailing address
9634 W ROSEDALE AVE, WEST ALLIS, WI 53227-3332
(920) 418-0460
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
585-039
WI
Other
Enumeration date
01/22/2015
Last updated
01/22/2015
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