Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 106S00000X | Behavior Technician | CO | |
Y | 224Z00000X | Occupational Therapy Assistant | CO |
NPI | 1003284696 |
---|---|
Provider Name | Ms. Shannon Nicole Lawrence |
First Address | Longmont, CO 80501-4508 |
Second Address | Lakewood, CO 80235-2023 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/09/2015 |
Last Update Date | 11/04/2019 |