Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics |
NPI | 1053768697 |
---|---|
Provider Name | Shantel Isaac |
First Address | South Ozone Park, NY 11436-1232 |
Second Address | Woodmere, NY 11598-2035 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2016 |
Last Update Date | 14/03/2017 |