Individual
SHANTEL JAY-PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ITDS
Contact information
Practice address
2104 LEWIS TURNER BLVD, FORT WALTON BEACH, FL 32547-1316
(850) 862-3728
(850) 862-6270
Mailing address
2104 LEWIS TURNER BLVD, FORT WALTON BEACH, FL 32547-1316
(850) 862-3728
(850) 862-6270
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
—
—
Other
Enumeration date
04/15/2009
Last updated
04/15/2009
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