Individual
SHANEAN TABOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
100 IVY CREEK DR, RICHMOND, KY 40475-6021
(317) 615-0036
Mailing address
100 IVY CREEK DR, RICHMOND, KY 40475-6021
(317) 615-0036
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
—
KY
Other
Enumeration date
12/04/2018
Last updated
12/04/2018
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