Individual
SAMANTHA ANN SHIELDS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
2805 HUNTERS TRL, PORTAGE, WI 53901-3429
(608) 745-4347
Mailing address
2805 HUNTERS TRL, PORTAGE, WI 53901-3429
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
4913-27
WI
Other
Enumeration date
07/16/2019
Last updated
07/16/2019
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