Individual
JOANNA ROSE SHAW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
16 LUCAS AVE STE 201, KINGSTON, NY 12401-3708
(845) 514-2094
Mailing address
17 CARROLL ST, TILLSON, NY 12486-1216
(917) 880-2975
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
010913
NY
390200000X
Student in an Organized Health Care Education/Training Program
—
NY
Other
Enumeration date
09/14/2021
Last updated
09/25/2025
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