Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 3780 | SC |
NPI | 1013499193 |
---|---|
Provider Name | Shannon Denise Richardson |
First Address | North Augusta, SC 29860 |
Second Address | North Augusta, SC 29860 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/09/2018 |
Last Update Date | 05/09/2018 |