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Organization

SHANEKA A LAVENDER, COTA/L

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MRS. SHANEKA A LAVENDER (COTA/L)
(678) 458-0699
Entity
Organization

Contact information

Practice address
55 S 133RD ST, CHANDLER, AZ 85225-6014
(678) 458-0699
Mailing address
55 S 133RD ST, CHANDLER, AZ 85225-6014
(678) 458-0699

Taxonomy

Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
5558
AZ

Other

Enumeration date
09/14/2016
Last updated
09/14/2016
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