Individual
SHANNA HUMPHREY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OT/CLT
Contact information
Practice address
2041 NE WILLIAMSON CT STE B, BEND, OR 97701-3941
(541) 633-7535
(541) 706-9036
Mailing address
PO BOX 7377, BEND, OR 97708-7377
(541) 633-7535
(541) 706-9036
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
1058897
OR
Other
Enumeration date
10/28/2020
Last updated
10/28/2020
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