Individual
PHILLIP SCOTT SHACKELFORD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OTR/L
Contact information
Practice address
125 GARY GLEN DR, MARTINEZ, GA 30907-2615
(706) 394-4015
Mailing address
125 GARY GLEN DR, MARTINEZ, GA 30907-2615
(706) 394-4015
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT006295
GA
Other
Enumeration date
04/25/2016
Last updated
04/25/2016
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