Individual
SHASTA VERNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTA
Contact information
Practice address
530 S MAIN ST, LIMA, OH 45804
(419) 841-2200
Mailing address
6361 WEDGEWOOD DR, SYLVANIA, OH 43560
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
OTA.05564
OH
224Z00000X
Occupational Therapy Assistant
Primary
OTA005564
OH
Other
Enumeration date
07/22/2014
Last updated
06/29/2022
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