Individual
COURTNEY SHADDOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
550 BAILEY RD STE 401, LUMBERTON, NC 28358-2424
(910) 674-4363
Mailing address
715 S 11TH ST, WILMINGTON, NC 28401-5326
(607) 267-9025
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
14519
NC
Other
Enumeration date
10/21/2021
Last updated
10/21/2021
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