Organization
MISS SHANNON S THERAPY 4 KIDZ LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHANNON K HOLMAN OTR/L (OWNER/THERAPIST)
(702) 970-9242
Entity
Organization
Contact information
Practice address
2449 N TENAYA WAY UNIT 34991, LAS VEGAS, NV 89128-9995
(702) 970-9242
(702) 829-5857
Mailing address
2449 N TENAYA WAY UNIT 34991, LAS VEGAS, NV 89128-9995
(702) 970-9242
(702) 829-5857
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003402345
—
NV
Enumeration date
08/17/2022
Last updated
06/15/2023
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