Individual
SHANNON TEGETHOFF
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTRL
Contact information
Practice address
7110 JORDAN DR, RAPID CITY, SD 57702
(605) 342-4412
Mailing address
1224 WEST BLVD, RAPID CITY, SD 57701-3517
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
0663
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5835410
—
SD
Enumeration date
03/29/2007
Last updated
07/09/2007
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