Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TS0200X | School Psychologist | SS1134 | FL |
NPI | 1053701888 |
---|---|
Provider Name | Dr. Kathleen Shea |
First Address | Palm Harbor, FL 34683-2641 |
Second Address | Palm Harbor, FL 34683-2641 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/02/2015 |
Last Update Date | 02/02/2015 |