Basic Information
| Provider Information | |||||||||
| NPI: | 1184960734 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SEGER | ||||||||
| FirstName: | SHANEL | ||||||||
| MiddleName: | LYNETTE | ||||||||
| NamePrefix: | MISS | ||||||||
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| Credential: | COTA/L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3689 N 33 RD | ||||||||
| Address2: | |||||||||
| City: | MANTON | ||||||||
| State: | MI | ||||||||
| PostalCode: | 496639694 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2319205369 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1900 S LACHANCE ROAD | ||||||||
| Address2: | |||||||||
| City: | LAKE CITY | ||||||||
| State: | MI | ||||||||
| PostalCode: | 49651 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2317753081 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/28/2012 | ||||||||
| LastUpdateDate: | 12/28/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 224Z00000X | 5202007376 | MI | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant |
No ID Information.