Individual
SHANNON TEADT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
1150 MICHIGAN AVE E, BATTLE CREEK, MI 49014-6113
(269) 962-5458
Mailing address
269 N MATTESON LAKE RD, BRONSON, MI 49028-9313
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
5202007819
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5202007819
OCCUPATIONAL THERAPY ASSISTANT LICENSE
MI
Enumeration date
02/26/2018
Last updated
02/26/2018
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