Individual
SHANNON WHITACRE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
425 LAURICELLA CT, ENGLEWOOD, OH 45322
(937) 836-5143
Mailing address
11681 ST RT 718, LAURA, OH 45337
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
03900
OH
Other
Enumeration date
09/22/2008
Last updated
09/22/2008
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