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General NPI Number Information
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NPI Number | 1376226050
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Entity Type | Individual
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Provider Name | SHANNON ELIZABETH MANTHEY
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Gender | Female
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Dates
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Enumeration Date | 08/09/2023
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Last Update Date | 08/09/2023
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Provider Practice Location Address
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Address Line | 424 DEAN LANE
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City | GARDENDALE
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State | AL
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Zip | 35071
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Country | US
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Telephone | 205-631-8709
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Fax |
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Provider Business Mailing Address
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Address Line | 1540 29TH CT S APT D
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City | BIRMINGHAM
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State | AL
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Zip | 35209-2428
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Country | US
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Telephone | 504-400-7497
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | 4868
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License Number State | AL
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