Individual
SHANNON LACEY DOHERTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LAT, ATC
Contact information
Practice address
1000 LUMBERJACK DR, DIBOLL, TX 75941-9701
(936) 829-5626
Mailing address
2807 DANIEL MCCALL DR APT 223, LUFKIN, TX 75904-7151
(303) 990-1945
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT8340
TX
Other
Enumeration date
03/23/2021
Last updated
03/23/2021
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