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Organization
SHAMROCK THERAPY SERVICES
Active
Organization
SHAMROCK THERAPY SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KATHLEEN BANTA OTR (OCCPATIONAL THERAPIST/OWNER)
(352) 804-0753
Entity
Organization
Contact information
Practice address
2910 SE 7TH ST, OCALA, FL 34471-2768
(352) 804-0753
(352) 620-2272
Mailing address
2910 SE 7TH ST, OCALA, FL 34471-2768
(352) 804-0753
(352) 620-2272
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
354
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
880196700
MEDICAID INDIVIDUAL NUMBER KATHLEEN BANTA
FL
01
—
881488100
MEDICAID GROUP NUMBER SHAMROCK THERAPY SERVICES
FL
01
—
Z1623
BLUE CROSS BLUE SHIELD
FL
Enumeration date
04/09/2012
Last updated
04/09/2012
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