| NPI | 1508256728 |
|---|---|
| Former Name | SHANNON R DICKEN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 224Z00000X Occupational Therapy Assistant (Licence: AZ 6063) |
| Additional Taxonomies | 224Z00000X Occupational Therapy Assistant (Licence: FL OTA13855-18960) |
| Enumeration Date | 2015-01-26 |
| Last Update Date | 2015-01-26 |