Individual
MICHAEL SHANE WEATHERMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
COTA/L
Contact information
Practice address
4124 PROVIDENCE RD APT B, CHARLOTTE, NC 28211-4479
(828) 707-7627
Mailing address
4124 PROVIDENCE RD APT B, CHARLOTTE, NC 28211-4479
(828) 707-7627
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
2880
NC
Other
Enumeration date
12/08/2010
Last updated
12/08/2010
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