Individual
SHASTA DAWN VANCE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
: 21 MCBETH STREET GREENVILLE, GREENVILLE, SC 29611
(410) 889-0727
(410) 889-0729
Mailing address
416 E 30TH ST, BALTIMORE, MD 21218-3934
(410) 889-0727
(410) 889-0729
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
3350
SC
Other
Enumeration date
06/12/2013
Last updated
05/27/2025
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