Individual
SHANELL L BLACK SOUTHALL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
9303 PRESTON RUN, GOODLETTSVILLE, TN 37072-1942
(615) 260-2978
Mailing address
9303 PRESTON RUN, GOODLETTSVILLE, TN 37072-1942
(615) 260-2978
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
5565
TN
225X00000X
Occupational Therapist
Primary
3691
TN
Other
Enumeration date
09/10/2008
Last updated
08/04/2021
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