Individual
MR. SHANNON LANE BROWN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
COTA
Contact information
Practice address
43 COUNTY ROAD 1721, BAY SPRINGS, MS 39422-9804
(601) 467-3476
Mailing address
43 COUNTY ROAD 1721, BAY SPRINGS, MS 39422-9804
(601) 467-3476
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
TA2354
MS
Other
Enumeration date
06/09/2011
Last updated
06/09/2011
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