| NPI | 1205155793 |
|---|---|
| Former Name | SHANNON KATHLEEN SQUIRES |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 224Z00000X Occupational Therapy Assistant (Licence: IL 057.002380) |
| Additional Taxonomies | 224Z00000X Occupational Therapy Assistant (Licence: FL OTA 11278) |
| 224Z00000X Occupational Therapy Assistant (Licence: MO 2003012800) | |
| Enumeration Date | 2010-05-23 |
| Last Update Date | 2010-05-23 |