Individual
JEAN R SHANNON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
19010 93RD ST, BRISTOL, WI 53104-9611
(262) 891-3359
Mailing address
19010 93RD ST, BRISTOL, WI 53104-9611
(262) 891-3359
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
1849-19
WI
Other
Enumeration date
09/24/2024
Last updated
09/24/2024
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