Provider Demographics
NPI:1437391117
Name:BROTHERS, SHANNON RENEE
Entity Type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:RENEE
Last Name:BROTHERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3236 HAMPTON ST
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41101-4034
Mailing Address - Country:US
Mailing Address - Phone:859-983-8132
Mailing Address - Fax:606-393-3356
Practice Address - Street 1:3236 HAMPTON ST
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-4034
Practice Address - Country:US
Practice Address - Phone:859-983-8132
Practice Address - Fax:606-393-3356
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-27
Last Update Date:2020-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist