Individual
SHANNON KAY WIREMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
10820 PARK PL, SAINT JOHN, IN 46373-8630
(219) 351-5214
Mailing address
3670 W KOZAK DR, WHEATFIELD, IN 46392-7373
(219) 964-8262
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
32001594A
IN
Other
Enumeration date
09/16/2021
Last updated
09/16/2021
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