Individual
MR. SHANE GILLESPIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
COTA/L
Contact information
Practice address
432 HERMITAGE DR, DANVILLE, VA 24541-5800
(434) 791-3180
Mailing address
432 HERMITAGE DR, DANVILLE, VA 24541-5800
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
0131000721
VA
Other
Enumeration date
06/30/2010
Last updated
06/30/2010
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