Individual
SHANNON R MANIGAULT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
400 W 5TH ST, YUMA, AZ 85364-2945
(928) 502-7811
(928) 502-7818
Mailing address
400 W 5TH ST, YUMA, AZ 85364-2945
(928) 502-7811
(928) 502-7818
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
6063
AZ
224Z00000X
Occupational Therapy Assistant
OTA13855-18960
FL
Other
Enumeration date
01/26/2015
Last updated
01/26/2015
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