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Individual

MRS. SHANNON IRENE SMITH

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
1625 LAKE MURRAY BLVD, COLUMBIA, SC 29212-8626
(803) 238-9464
Mailing address
131 MAYLAND CT, IRMO, SC 29063-2116
(803) 238-9464

Taxonomy

Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
10364
SC

Other

Enumeration date
03/10/2021
Last updated
03/10/2021
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