Individual
MRS. TIINA J SHACKELFORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
6688 MAIN ST, GLOUCESTER, VA 23061-5194
(804) 210-1555
Mailing address
PO BOX 130, GLOUCESTER, VA 23061-0130
(804) 210-1555
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
0131002409
VA
Other
Enumeration date
02/01/2021
Last updated
02/01/2021
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