Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 2013 | NH |
NPI | 1336764695 |
---|---|
Provider Name | Shannon Mikell |
First Address | Portsmouth, NH 03801-6825 |
Second Address | Portsmouth, NH 03801-6825 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/06/2020 |
Last Update Date | 12/06/2020 |