Individual
SHANNON CARLOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
1145 POQUONNOCK RD, GROTON, CT 06340-4698
(860) 446-9960
Mailing address
62 THAMES HEIGHT LN, GROTON, CT 06340-2856
(860) 237-0836
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
1710
CT
Other
Enumeration date
04/14/2021
Last updated
04/14/2021
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