| NPI | 1548752066 |
|---|---|
| Former Name | SHANNON WOODRUM |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: IN 36001839A) |
| Enumeration Date | 2018-05-31 |
| Last Update Date | 2018-05-31 |