Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics |
NPI | 1003371600 |
---|---|
Provider Name | Shannon Mcwilliams |
First Address | Garden City, NY 11530-2613 |
Second Address | Glen Head, NY 11545-1842 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/02/2019 |
Last Update Date | 07/02/2019 |