Individual
MARIAH NICOLE SHANE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
13574 VILLAGE PARK DR, ORLANDO, FL 32837-7689
(407) 990-2847
Mailing address
13574 VILLAGE PARK DR, ORLANDO, FL 32837-7689
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
18624
FL
Other
Enumeration date
01/13/2022
Last updated
01/13/2022
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