Individual
SHAYVEUNTE SHAORA PARKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
150 N 27TH ST, BELLEVILLE, IL 62226-6621
(618) 235-6600
Mailing address
739 PARK DR, ALTON, IL 62002-2716
(618) 969-1262
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
057.005827
IL
Other
Enumeration date
11/08/2023
Last updated
11/08/2023
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