Individual
MRS. KRISTY MICHELE SHAW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
304 EMORY ST, VALDOSTA, GA 31602-1808
(229) 244-1667
(229) 244-8253
Mailing address
304 EMORY ST, VALDOSTA, GA 31602-1808
(229) 244-1667
(229) 244-8253
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT0003399
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00919465A
—
GA
Enumeration date
04/08/2006
Last updated
03/21/2018
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