Individual
SHANNON MICHELLE MATTINGLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
790 N MAIN ST, SUITE 102, CLAYTON, GA 30525-4275
(706) 212-0661
(706) 212-0662
Mailing address
109 FLEETWOOD DR, SUITE E, EASLEY, SC 29640-2019
(864) 855-7030
(864) 855-7019
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
KY-R3598
KY
225X00000X
Occupational Therapist
Primary
OT004853
GA
Other
Enumeration date
08/03/2006
Last updated
04/02/2009
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