Individual
MS. SHANNON MARIE MASTERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
3504 WEXFORD DR, LOUISVILLE, KY 40218-2143
(502) 386-1072
(502) 324-7830
Mailing address
3504 WEXFORD DR, LOUISVILLE, KY 40218-2143
(502) 386-1072
(502) 324-7830
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
131933
KY
225X00000X
Occupational Therapist
Primary
131933
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
131933
STATE LICENSE
KY
05
—
7100080320
—
KY
Enumeration date
10/15/2008
Last updated
07/21/2022
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