Individual
MR. JONATHAN PETER SHADE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OT
Contact information
Practice address
1509 W ORANGE BLOSSOM TRL, APOPKA, FL 32712-2640
(407) 814-0436
(407) 814-0818
Mailing address
585 PRESTON RD, LONGWOOD, FL 32750-3945
(407) 814-0436
(407) 814-0818
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT1641
FL
Other
Enumeration date
09/14/2015
Last updated
09/14/2015
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