Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 02044 | MD |
NPI | 1043564495 |
---|---|
Provider Name | Shannon Marie Elie |
First Address | Bethesda, MD 20814-3035 |
Second Address | Bethesda, MD 20814-3035 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/11/2012 |
Last Update Date | 07/11/2012 |