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Individual

CARLIE SHIELDS

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
355 CROSSGATES BLVD, BRANDON, MS 39042-2602
(601) 825-3192
Mailing address
PO BOX 428, ORCHARD PARK, NY 14127-0428
(716) 662-4955

Taxonomy

Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT3072
MS

Other

Enumeration date
10/27/2015
Last updated
11/06/2019
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