Individual
CANDICE TYAN SHAW
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OT, BCBA
Contact information
Practice address
1000 ST. LOUIS STREET, SUITE 102, FORT WORTH, TX 76104
(817) 921-5020
Mailing address
305 NE LOOP 280, BUSINESS TOWER 1 SUITE 200, HURST, TX 76053
(817) 292-8787
(817) 789-6849
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
1-11-9504
—
225XP0200X
Pediatric Occupational Therapist
Primary
993772
—
Other
Enumeration date
07/25/2012
Last updated
03/07/2014
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