Individual
SHANNIN B VANDERARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3774 HOLLYWOOD RD, SAINT JOSEPH, MI 49085-9550
(269) 428-2799
Mailing address
3774 HOLLYWOOD RD, SAINT JOSEPH, MI 49085-9550
(269) 428-2799
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
5201007966
MI
Other
Enumeration date
07/21/2025
Last updated
07/21/2025
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