Individual
MRS. KIRSTI REBECCA SHIELDS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR
Contact information
Practice address
149 N MAIN ST, FAIRPORT, NY 14450-1434
(585) 377-2230
Mailing address
958 BOUGHTON HILL RD, VICTOR, NY 14564-9003
(585) 388-9005
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
012839-1
NY
Other
Enumeration date
10/23/2008
Last updated
10/23/2008
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