Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | TOP008420 | PA |
NPI | 1003188988 |
---|---|
Provider Name | Mrs. Teresa Mae Shultz |
First Address | Williamsburg, PA 16693-7146 |
Second Address | Williamsburg, PA 16693-7146 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/02/2012 |
Last Update Date | 26/09/2020 |