Provider Demographics
NPI:1255654802
Name:SAUSSER, SHANNON M (MAT, CBMT, MED)
Entity Type:Individual
Prefix:MS
First Name:SHANNON
Middle Name:M
Last Name:SAUSSER
Suffix:
Gender:F
Credentials:MAT, CBMT, MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 JOHNSON DR
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30605-2306
Mailing Address - Country:US
Mailing Address - Phone:706-372-3758
Mailing Address - Fax:
Practice Address - Street 1:140 JOHNSON DR
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30605-2306
Practice Address - Country:US
Practice Address - Phone:706-372-3758
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-10
Last Update Date:2010-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist