Most Relevant Information
Provider Data
| NPI Number: | 1003203282 |
| Provider Name: | SHANNON WALL MANGUM OTR |
| Entity Type: | Individual |
| Taxonomy Code: | 225X00000X |
| Specialty: | Occupational Therapist |
| License Number: | LZ10405 |
Most Important Dates
| Enumeration Date: | 04/24/2015 |
| Last Updated: | 04/24/2015 |
Provider Practice Location
1900 GRAVIER ST
NEW ORLEANS
LA
701122262
Practice Location Phone/Fax
| Phone: | 5045684302 |
| Fax: | 5045684306 |
Provider Mailing Location
1900 GRAVIER ST
NEW ORLEANS
LA
701122262
Provider Mailing Phone/Fax
| Phone: | 5045684302 |
| Fax: | 5045684306 |