Individual
SHACONYA LAFAYE WIGGINS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTRL
Contact information
Practice address
8715 GARFIELD ST, BETHESDA, MD 20817-6705
(301) 498-8100
Mailing address
15009 GREEN WING TER, UPPER MARLBORO, MD 20774-7060
(301) 249-7416
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
4839
MD
Other
Enumeration date
04/11/2007
Last updated
07/08/2007
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