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Individual

SHANELL L MANIBUSAN

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
COTA

Contact information

Practice address
2729 KING ST, ALEXANDRIA, VA 22302-4008
(703) 836-8838
Mailing address
9235 SOLDIER RD, FORT BELVOIR, VA 22060-1617
(210) 885-0500

Taxonomy

Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
0131002889
VA

Other

Enumeration date
09/13/2023
Last updated
09/13/2023
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