Individual
MR. SHANNON TROY HICKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CTRS
Contact information
Practice address
1030 JEFFERSON AVE, MEMPHIS, TN 38104-2127
(901) 523-8990
Mailing address
7820 FREEHOLD DR, MEMPHIS, TN 38125-3254
(901) 523-8990
Taxonomy
Speciality
Code
Description
License number
State
225800000X
Recreation Therapist
Primary
38504
LA
Other
Enumeration date
01/29/2008
Last updated
01/29/2008
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