Individual
ANN SHORT
Active
Individual
ANN SHORT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, OTRL
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
3368
SC
225XP0200X
Pediatric Occupational Therapist
Primary
OT003970
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
368569697C
—
GA
Enumeration date
12/13/2006
Last updated
06/26/2015
Update your record
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