Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 5210 | NC |
N | 225XR0403X | Driving and Community Mobility | 5210 | NC |
NPI | 1174892434 |
---|---|
Provider Name | Shannon Dunn Smith |
First Address | Wilson, NC 27893-8616 |
Second Address | Wilson, NC 27893-3428 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/12/2011 |
Last Update Date | 25/10/2018 |