Individual
KATIE J SHANNON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ATC/LAT
Contact information
Practice address
1206 N MAIN ST, MOUNTAIN GROVE, MO 65711-1025
(417) 926-5699
Mailing address
8160 WHETSTONE RD, MOUNTAIN GROVE, MO 65711-2553
(832) 318-5290
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
2018032324
MO
Other
Enumeration date
09/10/2018
Last updated
09/10/2018
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