Individual
SHANNON DITZEL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
1350 BLAIR DR, ODENTON, MD 21113-1333
(443) 871-4351
Mailing address
1350 BLAIR DR, ODENTON, MD 21113-1333
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
M05159
MD
Other
Enumeration date
04/01/2021
Last updated
04/01/2021
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