Individual
SHANNA NICOLE GWYN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
260 VILLAGE LAKE RD, SILER CITY, NC 27344-1820
(919) 742-4052
Mailing address
113A OLD SPRING RD, CHAPEL HILL, NC 27516-8140
(919) 622-4286
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
11866
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11866
NORTH CAROLINA BOARD OF OCCUPATIONAL THERAPY
NC
01
—
403214
NATIONAL BOARD OF OCCUPATIONAL THERAPY
—
Enumeration date
08/02/2018
Last updated
08/02/2018
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