Individual
MS. TONYA LEA SHAW
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
913 S LYNN ST, URBANA, IL 61801-5205
(217) 365-0299
(217) 365-0301
Mailing address
913 S LYNN ST, URBANA, IL 61801-5205
(217) 365-0299
(217) 365-0301
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
057.000686
IL
Other
Enumeration date
08/17/2010
Last updated
08/17/2010
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