Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 12252 | FL |
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 4379 | SC |
N | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 5320 | AZ |
NPI | 1376086397 |
---|---|
Provider Name | Shauna Lynn Henson |
First Address | Greenville, SC 29605-4270 |
Second Address | Greenville, SC 29605-4270 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/11/2016 |
Last Update Date | 22/11/2016 |