Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | OP002816L | PA |
NPI | 1023218104 |
---|---|
Provider Name | Tina Lynn Shawley |
First Address | Meadville, PA 16335-6364 |
Second Address | Wexford, PA 15090-9260 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2007 |
Last Update Date | 18/07/2007 |